This document summarizes a clinical meeting discussing a 60-year-old female patient presenting with recurrent upper abdominal pain over the past 2 years. Examination findings included tenderness and guarding in the epigastrium. Investigations revealed elevated serum lipase, anemia, and ultrasound findings suggestive of chronic pancreatitis. The provisional diagnosis was chronic pancreatitis, with differential diagnoses of chronic cholecystitis or peptic ulcer disease. CT scan and laboratory results confirmed the diagnosis of chronic pancreatitis due to pancreatic calculi, complicated by iron deficiency anemia.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
during my internship in gastroenterology department i presented the case, chairperson was my beloved sir Prof AHM Rowshan. this is a case about a 20 year old female presented with abdominal pain, fever which was low grade, and weight loss with marked anorexia for few months. the diagnosis was a dilemma. patient was undergone laparoscopic biopsy from intrabdominal enlarged lymph nodes and ultimately the diagnosis was a case of Non-Hodgkin's lymphoma and treated by chemotherapy.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
during my internship in gastroenterology department i presented the case, chairperson was my beloved sir Prof AHM Rowshan. this is a case about a 20 year old female presented with abdominal pain, fever which was low grade, and weight loss with marked anorexia for few months. the diagnosis was a dilemma. patient was undergone laparoscopic biopsy from intrabdominal enlarged lymph nodes and ultimately the diagnosis was a case of Non-Hodgkin's lymphoma and treated by chemotherapy.
CC I have itchy white discharge”HPI Patient is a 32 African.docxtroutmanboris
CC: "I have itchy white discharge”
HPI: Patient is a 32 African American female who reports having increased vaginal itching and discharge times 2 days. She states that her vagina feels irritated and that the itch is progressively getting worst. She reports a thick white cottage cheese discharge is present. She reports that she used a Monistat 3 day 6 days ago but hasn't had any relief. She states that the pain is worst after sex.
PMH: Patient denies having any past medical history. She denies any past traumas or hospitalizations.
PSH: Patient denies having a history of trauma. Patient denies having any surgical history.
Allergies: Patient denies having allergies to latex, food or any medications.
Medications: Patient reports she is currently on no medications.
Social history: Patient reports that her entire family lives nearby. She states that she lives in a two-bedroom apartment alone. States that she drinks 3 glasses of 8oz glasses of wine with friends twice a week. Denies recreational drug use. Denies tobacco use. Reports that she is single. She denies having any new sex partners during the last 3 years. She states that she drinks 1 8oz cups of coffee daily. She reports that she has worked as a real estate agent for the last 2years. Reports no job-related stressors.
Family History: Patient reports that her mother is a live and has a medical history of that she was diagnosed with anxiety and depression at the age of 35. She states her father has a medical history of depression which he was diagnosed with at age 45. She reports her maternal grandmother had a history of COPD and CHF. She reports her maternal grandmother died from complications of chronic kidney disease at the age of 80. She reports that her maternal grandfather had a medical history of hypertension, she reports he is still alive at 88. Patient reports her paternal grandmother has a medical history of CHF and diabetes mellitus type 2. She reports her paternal grandmother is still alive at 85 but has dementia She states paternal grandfather had a medical history of COPD and CHF, she reports he died at age 85 from complications of diabetes mellitus type 2. She has two older sister who both have no medical history.
Health Promotion/Maintenace: Patient reports she had a flu shot in September 2017 in a private doctor's office. Reports she had a TDAP booster in 2014. Based on the patients age USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. Reports she had a std screen 2 years ago. She reports that she has never had an abnormal pap smear. She states STD screen was negative. Reports she had a pap 4 years ago. She reports she does monthly self-breast exams at home. She reports that she eats 2 times daily. Reports she eats well balanced nutritious meals for each meal. She reportedly drinks approximately 30oz of water a day.
General: Patient reports having, fever, chills, and malaise
Skin: Pat.
Support with 1 journals no older than 5 years.Week 8GI Case .docxrudybinks
Support with 1 journals no older than 5 years.
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medic ...
Week 8GI Case Study H. Pylori infectionQuestions As an.docxloganta
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and failed.
Clarithromycin 500 m ...
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. A 60 years old lady
presented with upper
abdominal pain
Presented by-
Dr. Jheelam Biswas
Intern doctor
MU- 6
3. ParTiculars of The
PaTienT
Name: Mrs. Hasi
Age: 60 years
Sex: Female
Religion: Islam
Occupation: Housewife
Marital status: Married
Address:
Rupnagar,Narayanganj
Date of Admission: 24.01.2014
Date of Examination: 24.01.2014
5. hisTory of PresenT
illness
According to statement of the patient she
was reasonably well 2 years back. Then
she developed recurrent pain in the
epigastrium which was constant dull
aching in nature, radiated to back,
aggravated by taking fatty food and
relived by bending forward and taking
6. medication. The pain had no periodicity.
The pain was sometimes associated
with nausea and vomiting, which
occurred after taking food, and
contained undigested food particles. In
some occasion the pain became
sudden, severe and agonizing in
nature and didn’t relived by taking
analgesics.
7. For that reason she was admitted to
hospital 3 times and was treated
conservatively. She gave no history of
fever, jaundice, heart burn, chest pain,
respiratory distress, no history of intake
of any NSAID before the onset of pain,
haematomesis or melena or weight
8. loss or passage of loose stool. She was
normotensive and non-diabetic. Her
bowel and bladder habits were
normal.
9. hisTory of PasT illness
She had undergone hysterectomy 10
years back and had surgery for ovarian
tumor 8 years back.
10. TreaTmenT hisTory
She was admitted in local Upazilla
hospital 3 times and was treated
conservatively.
11. family hisTory
She is the 3rd issue of a non-
consanguinous marriage. Her oldest
sister died due to hepatocellular
carcinoma. Her second sister has same
type of illness, but her youngest sister
is healthy and alive.
12. Personal hisTory
She is non alcoholic, non smoker and
doesn’t take betel nuts or betel leaf.
She is accustomed to the normal
Bangladeshi diet.
13. socioeconomic
hisTory
She belongs to a low socioeconomic
condition . Monthly income of her
family is about 5000 tk. She lives in a
tin-shed house, drinks boiled water,
and uses sanitary latrine.
17. generAl exAMinAtion
O Appearance: Ill-looking
O Body Build: Average
O BMI: 28 kg/m2
O Decubitus: on choice
O Co-operation: Cooperative
O Anemia: Severely anemic
O Jaundice: Absent
O Cyanosis: Absent
18. O Clubbing: Absent
O Koilonychia: Absent
O Leukonychia: Absent
O Edema: Absent
O Dehydration: Absent
O Pulse: 86beats/min.
O Blood Pressure: 120/70 mmHg
O Temperature: 98 F⁰
19. O Respiratory Rate: 20 breaths/min
O Skin condition: Scar mark present in
the left lower paramedian region of
lower abdomen
O Lymph Nodes: Not palpable
O Thyroid Gland: Not enlarged
O JVP : Not raised
20. AliMentAry systeM
O Oral cavity, gums, teeth :
appeared normal.
O On inspection : abdomen was
normal in shape. Umbilicus was
centrally placed, inverted. There was
two scar marks in the left lower
paramedian region. Her hair
distribution and
21. external genetalia was normal.
On superficial palpation: Local
temperature was normal, Tenderness
was present in the epigastrium, muscle
guard and muscle rigidity were present
in the epigastric region.
On deep palpation:
Liver and spleen were not palpable.
22. Both Kidneys were not palpable or
ballotable.
Murphy’s sign was negative.
Fluid thrill was absent.
On percussion: Percussion note was
tympanitic all over the abdomen.
Shifting dullness was absent.
On auscultation: Bowel sound
present.
23. cArdiovAsculAr systeM
All peripheral pulses were present in
all four limbs symmetrically, in all areas,
with normal rhythm and volume.
Palpation: Apex beat was felt at the left
5th
ICS 9cm from mid-line. Apical thrill
and para-sternal heave were absent.
24. On auscultation:
S1 and S2 was audible normally in all
four areas and there was no added
sound.
25. respirAtory systeM
On inspection chest movement was
symmetrical. No deformity present.
On Palpation: Trachea was central in
position and apex beat was felt in the left
5th
ICS 9cm from midline. Vocal fremitus
and chest expansibility was normal.
26. On Percussion resonant in all
intercostal spaces.
On Auscultation breath sound was
bronchial on both lung fields. Vocal
resonance were normal, and there
were no added sounds.
27. Nervous system
Higher psychic function: Normal.
Cranial Nerves were all Intact.
Motor system: Intact
Sensory System was normal.
Signs of meningeal Irritation was
absent.
28. salieNt Features
Mrs. Hasi, 60 years old, normotensive,
non smoker Muslim married female,
hailing from Rupnagar, Narayanganj was
admitted to this hospital on 24/1/2014
with the complaints of recurrent pain in
the epigastrium for 2 years.
According to the statement of the patient
29. she was reasonably well 2 years back.
Then she developed recurrent pain in
the epigastrium which was dull aching,
constant, radiated to back, aggravated
by taking fatty food and relived by
bending forward and taking medication,
had no periodicity, and was associated
30. With occasional nausea and vomiting
which occurred after taking meal, and
contained undigested food particles. In
some occasion the pain became so
severe, constant and agonizing in nature
that she had to be admitted to local
hospital 3 times and was treated
conservatively. She gave no history of
31. of fever, jaundice, hematemesis, chest
pain, heart burn or respiratory distress,
no intake of NSAID, haematomesis or
melena, no weight loss or passage of
loose fatty stool. She had undergone
hysterectomy 10 years back and had
surgery for overian tumor 8 years back.
She was habituated to normal
32. Bangladeshi diet. Her oldest sister died
due to ovarian carcinoma, and her
second sister was suffering from same
type of illness. She was non diabetic and
non alcoholic. Her bowel and bladder
habits were normal.
On examination she was severely anemic
33. with BMI 28 kg/m2
, her pulse was 86
b/min, BP 120/70 mmHg, respiratory
rate 20 b/min, temperature 98 F.⁰
There was two scar marks present in
the left lower paramedian region. There
was tenderness, and muscle guard
present in the epigastrium, but no
organomegaly, or ascetics was present.
42. Investigations
(on 14. 1. 14)
Findings
TSH 3.6 U/L (.0.4- 5.5)
S. bilirubin 0.7 mg/dl
S. calcium 10.1 mg/dl (8.10- 10.40)
Urine R/E Normal study
Blood Group B positive
46. usG of whole abdomen
Echogenicity in pancreatic
parenchyma with irregular
outline. MPD mildly
dilated.
Spleen mildly enlarged (12.8
cm along long axis)
Liver normal with
homogenous
echogenicity., with no focal
lesion.
Suggestive of chronic