Table of Content: Name of Case 5 Peptie Ulees od) veare Be Rena Stone | 3. Clwonre noe eystitin lu. Coneino Benign Enlargement Oh Prostate ee Recwuent appenclicitis 6. Carcinoma % dosaost ; Obsruthie Jaundice u to jt: Gaxtue Outlet obdvuctien dure | costinona py tlometh | Gostrle OuHet obituchion due te (a. pyre atemoes, to. eng 7 toe | Page No, Ol- 08 09 74 Is - 20 | | a - 26 a7-3yRarbiculoxs othe Patiewt : Name > Md. Abdus Sabin Ag. 4g Seat Male Ratigion ~ Wan Occupation — Former Marital Stetiy Mlawued Addxess - Bank Colony, Savon Aate ct Admiwion *, U/09/2024 Aate a Examivation 13/09/2021 Bed number 502 word Mediune male ward Claes complauuts °, 3. Recwment upper bdo mival, pe or Tonos, a Vovinting ier 8 times for lost 2days Hn 4 Pret Sunes - According to dhe Staterneck 9 the patient yhe was nose ely en ne developed vecurArcoe upp well T wiouths back. abdominal er ‘The ren yoy burning ir nakure and more manked iv oneet stomach , The pain vsually ctasted tn the upp» dladomen and then Andiated to dre back onal whole abdomen . ‘the yon aggravated in comply stomach ad the petiene yuk better apter havin meat or outacid . | . aMe po ddl not rely, on en formnree + The tat alg gove win oh ce Eryvequent rmeprago table, to set fy Pain. the posh Los arcociate uth heat bum Yeching andl | Mauser . For the last to day, he gett some ope % pain Ae | $epsiue vegion bud it wos severe fu Auten He aly | complasnet 4 vomiting i” 3 erodes { the come dah yy, | Voenibus wou, wow proechle , Mon Fidus and de vomitus tontauinedt un gested tood materuat vatlout presence on blood . J r *% e He i von. hypertensive , Won WUabede ad non + Asthamatic’ . His, boone Ond bladder Mrabits ane segulan . vith thig—eo these Complou nt, we get admitted ty &MCK fer bette munagremeng History ay Past TUnen He gee no clgwpicant medical or 5 adwattied to hosptat bere | Family ity: | He & Henea unth a grt ond Lives Lath hur Vaye onal danger, | rene no ee o dmilas ae % WUnes tn hy vey . AU hu, oy MLM one “pesenty heat Personal ustory - wagicat matory and Wet ney ex, Dick Vs nova. Alergy & leent He govt hotory 4 smoking about 10-15 shea of Cgaxedtes re clo jor lot AS yrs ho+ | ne | Soo'o- economic. istry - He comes rom ao middle claw yng - He Uves 1 & buildin | i fr and dxiuts woeter yon supplid source and uses souttary (ating Tanrwuni sation History « He is not well fenmunized — os pe CP] suwdule Drag Huyton « He gee al 4 taking prepreg dabets oval antacds nteasiovally jor reli, op his pen thse & no Wibtory vp faking? NSAIDS OF sexoroly . General Examination * Appearance Nowat Booly built » Average Co-opesation Co-operative Reaboitus . On hover | Anemia «Absent Taundice . Absent Cyano ss “Absent aera “absent Koilonydma : Absent Leucorydica Absent éduma - Absent Aehydnation Absent © Pulse . 80 beats /mvin Plood Prarine 120/90 wm m 319 breaths Irvine “eg tes tn Hat gawd: vial enlarged Syste mic Examination Airventaay System : Lin, quew, teeth tongue aud oral Couihy -normal Abdomen Inspection : Shape 9, Uneite abdomen normal umbilicus - teatradly placed and fava ted No uivible wouling y; pouistal ss, sengorged vein , SCo4may, Pigmentation . Patpation - 9 Supengiclat palpation ° = tendesney, not poet — Wo lotal wuse 4 eee - Hee & no muscle guana > var papation e, - Auodenal pout tendennes - Mesent - Gastne point tendesnen - Absent » No ogeronneg aly Percusion 1 Percumon node - Tyempancé Upper border 4 Ue dullnem - 6% pntencovar ™ No Waifting olullneys,a. 2 2 @ FD FO ee ee er—— IT” \ | Aweultation - Bowe wound — Present | Condi | chi | ovasentax System - Pulse. 90 beats Zrma Blood presune . 120/00 mm SUP» Not vauneg Pre corctium Taspechon Z Mrape oy Coetnvernal No degourae No urubl a pulsation 808 Mask, pqrrentation \ Patpation » Apex beat. in wae 5% inferostal space olmg he wid clavimdas Lie Jem avoag tym mud Ure 4 lest porasternad heave > abvent > Patpable A,- abcent 5 Til > Avent - Bpigastree pusation - absent youn ae normod eseat end auiculole in Auscuutabion * ist og 274 Mneast ou yo Oneas ob No muamur iv Resinatoy psi laaspection : rape 4 ned - Chest movement * Koay aes vormal normal ath, Jminude canmask, pignrenrne g Ho virile iwoulang > pulsation, 5Fatpation : Twachea, - Central. placed. Apex brat - Paupaiote in lege Sth Patercesiml pace Jey | ausay From midline . Vora fremfu + Normal Chest Sen *. Normat Pescussion Reovant Auseultation: Breath round : — Vesteutas Voeat Resonauee * Korma No added round Alevous stern > Higher Peychie funeton < Normat 9 Cromiat vee + Jntock 9 Motor pusttion Nlormac, ? Keaton puntdoo « xlormmat > Coober yo Normal ? yrs 4 agi treitettion: A bsane Mustullo skeletal bysteen » GAL Sereeng NormalSabient Features, B Md. Abdus Sabin US gray old, Musuem , pormoten ke , non- Watoelic nov nee » monde L 4am railing rom Baut soleny Svat, ‘ ek ab odentttd t+ EMCH om 1% Sep ber 023 «sth complaints veCUAnene uppia Alodowinal pei for last Tmonts ovd Ba eprodes % vom ln tr last delogs Pain wos burn in nohne | I wadioled to de back and whole abdomen - TA aggravated on empty Gomath and melita on tabi meal ov antacids . Foy tris he wed t Hake agreguent 0 ryote tobles . for the last 2dlays be Uk game pur in uppes intess ana. associated unt heart buns vb Weching). He als complarnea. Yon. Vomiting was nor AU Dus vomiting dhe 4or some dusabi abdomen whith was more severe on now - proenie ond couarineal Uncut ese, yea mare l » Da gnnet exomination , be 9s normal Deoki"g an average pod bwlt , pube $0 bpm, BP (20/90 mmHe © oem jaundice, dubbre veucomry cco, absent: [% Aldomiial —era- ano vs , KoiLonytcer ) tendemnes » othes eyitene miaabor | Ynoe & Au odenak point examination poveale 0 abrormolile - Acute emaces vation & pepe ulcers dsecse Provita nat daguos : Driysereation diagnos if Tavatigation 4, complet blood count a, Soum arnflare alee 3, US6 whole Aaloadone? 9 ; a, Upp 41 endo epgoo | Taeatrnent \y Omepapsie 20 “4 J2 hourly yor 4 wort 2. Amow'd' in 44 4 cea fer 7 days 4%. Con Hacorny te 50004 de ounla {" 7 laws Follow ” : Ajtee J mon, Advice 4 quoide srnoking) 2. avovdance 4 food shat ena g gerates the pre $. Take nequion mead Ww. Intake % dleq uate water .. Adequate ma pepe Heep C. hoa NSAIDs | StesoudyRartulors 9, tre fationt » 7 Nome *, Mustays gus Rahman Age + 30 years Sta. Male Religion Blam | Manttal status» Maywied, Occupation . Fawmer Address *. Thana Read, Savan date of adraeionn + 26-07-2024 Aote vy, tnominaboy 97, 07, 2025 Bed number * 524 word + Surgery wake word One compladuts 1. Poin in lagt loin for {year 3. Oeeavioual yerer fpr 6 months s+ Rassage 4 ohood maived wine 4°" Tecate Hastory of Rovesent Sllnes Recording to datement patiot , we wos seasouably wo } yeas wok. Ther he eae duuelopea ye to agit loin vith & dull, gird with no radiation aol aggravated ‘4 tg ically dung arfrnblag tous, and sere by wedlica iow, vormetines it wines with yudden ¢vanp pain , mo usociation wsith nowsea and vovnttng avd takin ord avd he fa how, become ae sere ta last day, . He oso vonage 4 otcavoual yor ‘er last 6 ales months ysuida ‘8 ayoumdA = GTite ells ond sulgor , relievrd ter a medication . ovd wong es ap leone” ts nat mugeted «Me hs aide com tlanest jth % assoviatel ust occasioual jev% " lost 6 moutls LoWch os i, Cis awd signs oelicud after taki? wedication and ening 5 ; aeported. He aso coruplasned % vase Hf turpentine 190 wot er pouvirg blood auyed stl une varie pang, art 1 omourg Hrras—adlvo owplained a peer blood -miyedk Wil urtne —srhuth, is pee He has no othe bod aud bladder complains . He hos 00 aa 4 trauma.» He has no hier o Wood tenfun'a,, He bas mo cough, Chest pain, hemoplyns ounclice sbermarenre cs Waltine java Coutact & TB patient . poth atove Complarnts We got sg homed, adedttea tn sagen moana oF EMCH for butes a aad 5 Hiory 4 pest TUness « No Lite “4 Diller, hypatension , asthma Perrone, witory : Non- gmokty non alcoholie Foanuity Wivtor AW iter memoers oy wis [ere ery good heart, Socio upworie Watery: He belong, Low middle claw \ “y Unnmuns sation nn Mes wot fethy immune ceo to CPL dae clue dey history We tok fome medications cw ake | borat Pharma oe,| | - | fepaton No organo me gay | Percusmion - Syenponive Auscutlation + Bowel found present i DRE = Reveals no abnoranasty | Gentto in Syste : » Testy: Normal 4 Penis, external urethral meatus, gloor a anterior: Normal >5 : Unekbra > No eupra pubue pullnen. or fendesnas Kideey 7 Not allo table Rigut yenaL ougter tenolerness » Cuenert Other ystems, No abnormalutes Galion Feakures * Me, Musapigur Rahman , B0.years old waricd arog muslim, non smoker, 10m aleehole , nor dione, mon pypeseasre yore a from Fyne Rood ,Savar ciolmitted. to EMCK wth tovglnints, 5 paw ta slau : pine with no paoddiaton aud aggravated 4 wry pon dung Climbing stu, and aeliewed 4 mmedcatton, sometones Lal ford. yean wich o duh, it come with — sudden shang pun ino cuseciation itt nausea anc vomiting ang ty yok and pan nad, ua — | General. Gaminatio Appearance ~ Apaiows, WU looking Body wilt. Average Cooper atvon * tooperatie Aeculoitus ty cvorce Nubitlon average Anoenva as MEd anemet Foundite. —alesent Cyanosis absent eI) . absent Koilomynca aboot Heutomyund . absint dakusdxation - grcent edeva. absent Rabe, BU (rninute Blood pressure | (20(70 my Tenugoature + arr Roiatoy Rake ~ [dl minute bymph ucdex. yat (apa ble ‘yen " Obsent Systeme eramination - Abdomen * Inspection : Aodomen U, vormar iW wise ond vrape , umbilicus TvOkerA the ae no ville yury OF seam ork . Hernan orgie futaetbecome more woe ¢ von — . fm (ast 3 days. He also commplanecL 64 pteaonal fever for last Gmorthe valvtly 3 e % : 4 aswulaked wily and sugon y sliwed, aM vst % after ay meditation and wenin | erature | ae (eas oh ted We has also col me | a aba wilith y pa, | in owount . He has | vo other bladden avd bowel | ie conplarn, te has no other bladdes oad 0 ‘a. cd 0 a as no Wudoi r fouma. He las no wistory a d Hanstudon, cou A , ot loo futon, gh, chest ; hemephyecs sjourdlite ywolena rd wovtott wth TB ae Dn general enamivation , he & Onntous, Looking, toptratre » veragee body buile avd nubutionalL dotw, . Pule 8U erin Br 130/70 , RQ -lU Jenin Yempecahune norma ma debydxation oud oedema , He is non avaemic , vor ecterie ye gpanows 1 na Lyrapradanopathg 5 towns : . . -. i u Us te se wsinay ovo asian wysteem , every wy nom aaminah'on ence aga pend angle Wendeaner, Chen Sern evemire nultals vo alnoswalit’es : | Provisonal adingnors . Right ded renal stone | oy perentaat diingnors : Rent 18 Investigations . | for diagnoss 1, ray KB +. VU gs, ultre soundRoutine» CBC Uning &ME Kardon Qlood Wugar &. creatinirr S$. talcium Chest Yeray? eta Hoag . Coweta Biagnows : Rigut sided renal stone . Tatatment *, A Conservative . { talewe lew tron 0.Scm Pty sate idake » Papa Cadse , outiboes ,WSADs B. Sungear Modern method : Percutaneous nephnolvetorn Entra cos gareat Wok waue Uh sicipry Eswuy PCNL 4 Ewse Hu ~ Raete PMY Fplottetons Catended pytlouthoto Nepin iteobmg Pasrtiat replat , "JPartiwlaes “a, the Pabent Name Sum Haluincs 7 Age . Ages Ser Feywale Ruigion » law Monstal Stata + Mawued Occupation House urbe Addaws Genaa Baran, Savas obate 5 admivion. 09 /g/202! aak 4 Eranivatn 99/99/2025 Bed umber. 31) Ward» Suegery Female Voaad Chie Cowplasits ‘ 1. Pain in right uppee adore for Sgean 2. Dccadonat jue awd vornting $7 6 months , History 4 preset {Unos fecovding to the gtaltment oy the potest she Was veaovally well I- ras ack » Ther sre developed pain in signet upper Abdomen uwith & ni 4n nature #0 dating to back oy suc gnt nde of Chest, aggastled Py [ety foods and aeliewed by meditation, aswutated with viausea, Patient bos vimilan attacks pen por last J yeas ‘altialle at au wnteuar 5 3-U manths , but for ost tne month patent is Waving dud Athsing constr pn tn right upper hal 4% abdomen , Otranonally poin dy abtociated nn| With vont jor las bmonihe . She used to vomit 24 times yaj } fea Fur nature, yorntes containing postal atqitea a \ stained , patter tv tote here os Hulitory oy ever Teermittenty wot Chis and a with dhe atlack, ah pun fer last 6 month, Hohe subwded sl Out - pyre . She has no ea 4 Bo od tron Wey use » tathoving no Rig sensation . She has ho Wityr, I Loss my aperte , rodignt boss and frequent prssag: a Leow Ho, Hex bladder abit i, vormal, Gar bat no Mito 4 Cough , chet pal toughing out blood , yeiow tolovahin tkin or Ye 0) Wack stool or bone pe. >| e 4 | Hilary 4 fast 1Uness - | Se has vio Mir % Dlabebe, Mebutus 1 ypeste actor east disvase 5 asthma tubesculo 4, Personal wivtory : Patient Os now swmoker , won alcolaotie lwmaunigation wistony Me & inmiunlbed os pe EPL seedute . Socio - economic Wubtery « She bolouge tr a middle clos forty jive ta semi- pacha lowe avd datuks tube welt wake use ae suitor latoune Form Wty , AU ols mnerdorare—o} werloena np his yng Hyg good health . Mensruat. hiitory . fy 4 mendsche : 19 years Menstrual ei - 24 Pda, Menstrual povod 7 4S days| | imp: 02.09.2024 | Menstrual flow : average ag m lost hid | 1s yeons Deg history « She took sore tables trom Local quack lait could not mention names « General Ecamivation - pearance 1 Woking Body build > average toopesahon cooperative Deeuotvs’, — Onchsice Nubitional Status * Average Anaemia i+ Foundite » abvent Lyouors 2 alovent Clubbing + abyent Koilowyda + abyert Leucory vr 1 abyent edema 5 abyert Auryaration pot Pulse «(102 [mnie Wood pomnre + 190 [90m He Resivatory Rae * 1y [min Tompaatare — 100° F tyme note : not posyavle Yaypomne gy + Obseat eck vein +. mot engeryenAb dominal ¢ ‘xomivation * | + | Inspection x : eaghove | Movement vor respiration : Thoraeo -alodommal ovum | Unbiliiws Centrally ploced. , inverted | Nb seonemask regnrget vein, vtvole pordaleds | puliners Ih Heat be jporheudluuns : Patpation « Temperature : wot Vativeck tendenes . uot tender no palpable mass, muscle Qurd ov hypex ethe veo Murphy's "gn - negative Uver » spleen, Kidney , UB: vol PAlparole lereusvion -, Yrpane Fuca Shit ong “ng dUllnew ‘absent Auseutlatron » Bowk sound present PRE. Rewrated ho “trorwaity Nervous System Examination » Revealed vo otonor maliey Kepiaon bye framination wealed no Pero rmality / CVS toamivation » Revealed vo abnormality7 pf | alien, Feature : Mri Begun Haduma ,U0 years old marteied , murtion , vom srnoker MOM Oleohoue , Yon diabetic ,nopmotendie house cuit » hailny (rere Gerola Bayar Saver with adnuitea t& EMC vote complamts o> pam in a wpper Abdomen bey 4 yeas taitiaUly at on fakesval 3-4 months but iv last one month patient hs have dull adlatng constant pain fo Suge upper halts Oh aldovnen , Deowiowably ypaie astotateg ule vat for last 6 months. She usd t vomit 2-3 hwy douly , prejectie in nakue y vomitus eovtainin pastuly igestea pods , bile slaunea., brtter tm toate. Thene 0, budlony os eurn Trtenmn themtly wth Calle ome viljor wk attack of pain gov (ast 5 months, hide qubacled wrth audi pes. Ye has wo aol a hood brams tution 1 Ty dug use , vio ithing sensation , pe ar NO wdstory q eg agente, SB low ond Bauer pong 4 loose stool Hes bladde, halt is horeal. She bes vo history 4 cough y Chest fawn , hemop tyes , joundice , Walena or bone pen Om genera excmnivation | thes TU oad ; Cocyenatus 9 Average body built ma nutribvonol status pulse 102 minute BP 3230/9 . RE, [Us minute , Henparuae normal , no dlehyeleatrion Aud denna, pee Hee S non aes ANdemle —, MoQHAnDGs , ho feueatte | no Lympnadno patty thysomeg ely . On abdominal examination oldormem is caper thopea ie i umbilias cenbanhy plated. yo star maak , engerye “ey 7i tenepereton horrvial qyuaten omen Ow palpation, MO Cereebng, " munphy's san negativ. — y ple woe, weg “yr 4 (7 ey me no Grupare on porcuwon avd bowel ound — present Pigital yeetod eaornivation srveals no abvormality. Othe. SY Obra purtals Normal fusliags Prov'voual iognoris » Choa Onelecystrtes Djerental diamovis : pub Cone pavrereatalzcs Investigations . for dogo + US6 op HBS orth pancreas Routine - CBC Urine RMG Ravdom Wood Sugag Serum Creatinine Chest Kevoy Eg HBsAg Tsaakment - Ueestectorng This may be * Ope - tepasosonie :Particulars othe Patient « Nowe + Jonrat Bruyan Age » 60 ) ytons Ste. Male Retigion CC Marital Motu, : Married Address : Homayat pun date of odemivion 25+ 04: 202! ate of enaenivation ~ 26. 08-2024 Bed vumbver + 870 Wava ', Surgery Wrala Baa . Cig, complaints : 2+ Tacarased peng ond uagency *b mittwation gor Syean 2. ippieuyy in mictuvation (rv J mouths 3. Avule nuttntion 4 wine 6 days back, Hi; 4 pen Trew ° bm gratement patient , Racneanen frequency aval wegen Ivibially about. 6-7 two months 10-'2 Acordit ye WO ptasonaleg el eas bork the he goats deruapta 4 vattuvation oth ta dag and wignt time. fies 0 dag and aes time wight bal (or Cast times a day od 6-7 Hemes 0 nignk aswoiated with ung oro seenionak pucege oy ye segs bypre nea chiog the toiled , He had fy wake ap gor rnidturabion ve Hines, He ate yorerd diypioics { w tak 9 ronis om 7" %S ee yrream , vot impor 4 abrataing nother wp ayouated wo we vn mnittuvation + 2na teaminal UTE” ant, | — vith wrt, ae back jhe wdderl pet we seconpe * ee aad copneregabion AS ang fy ay od wo i Hin bowel hat & wormas He nds Wo Ary, Ce ope he pon typ Le I Serer pal, / hrumentartion » pods 2 an. avd v0 110 sethval. WANUMMERTERIO?Y Hr ay, compat we git Wiel adnate 9 SNC OKO eracy lr bette rae agenat Hist fost Sunes * No itor 4 aiobete, melts , hy portenston , rela forduovastuley cliyecue , Poxovad Wivte Hen ae . fomiy ca Au vi mum bers of his 44 eng Good heck No owe ig wg gering fre ey prostalec dusecne - Sovfo-eeonom ve ‘stort A We won te low middle Ads gaunt Irommun gation — histo Not tie ewig fo EPL guUhedule , i hairy He book some mecdicatron suggened #7 local prance toulla not pyertion dhe Meme v _— _—| | | | | Geert Entomination « : Apeoronce Tu looking? Booly buile > average (Co operahion * Ce Weculoits:, om Unovee Nutyitvon > average Anaemia . obsert Saurauce : — abvtrt byauo ws abvent Clubbip * abet Koilons chin « Obrtet deucomydnca + bent aegdsation : Abient Oederwe = * beta Ae ydratron S abyent fulee © 2Y/ mien Plocd presse. 130/90 mn Rempoarun AF Cogent 15 Lenn 4 Not palpable Byeds Not patpave'e hh wt Siplomie Exammivation * Gentousivary sytem . | Testes © Nomar Penis, enteral wr tthral meatus , por" 4 ontoudr urethra; plormad No wupre pubie tendesmness Cakhetes im atu Bom abet , | Kidney No erganomegaiy Pertusion T mpance Ausewlation : Borel sound present Yon vrectal examination *. Vwapech’on . No skin rash or exconation No tor or ‘ia ov onal ag) Paspatron Sipe moderately enlaggea Suspace » cmodth, Convey earl . pio overlying 2 mucosa » Kectol mucosa tan be made fo move over prostate midliec wueut + melon gul cus cadeups pot oun nebo betreen wig one Lest Lobe, 8 proatle (& Uswallyy Love Othe» systeon no Albnos may au | | | I I , I i 5 i a cuter wath drawl o MG > conTaing no blood , w a & i beeSalient Features * Accorching bo stattrnent of patent , ne war reawovally wel yeas bow. Then he go deweloped Tu vteased, ees wa urgeney 4 muduration both in day ora niqnt- He had ty wake “” from yeep 4. Ve also nob'ced cupip'culnes 1 yor mithwab’® several tm for" sly@m_ , not wnproved bp wvituration fer lat Otimas.os ee" o Shroining giotines St P pavotlated by esitency 5 intennittency cael denmival du idling swith ene 4 incomapeee eye cuatyon + 6 days bowk , he wuddente a ae acute ysretention anol eethrroter cathuiabin was olone bo suieve the rutention . 1, bow Youit & vmal. He bos a0 ml uy hematwua ov pees voegut lox , Cour, hemoptyss , chest pain , bore pain .rourdtce » Lith above camplainls, he gal Wine dh admitted 1 weg oy tard op eNcK. On gareran exominatron she avaious , boy puile and nubatronal status . Pulse Bimin BP. 130/490emm 49 , RZ is/min , tempereura GIF , no deydsatron ond oedema | hon eetoue , no cyenouis yno lyephadinopathy , fa ote WW Looking , woperahle , oversee He ig non ondemne , Yyromegen » engorged vuin- en Cakheoter On _genteurinery ond abies cyto, event 2s nwsmab Dr DRE prostate & moder ahty a «Swot, Comey sunaee fom ton'ittowy , retel mucosa = tan be made to move ous te prostate Medion sulcus alwys preset. aistinchen between cignt ond Legt bbe 4 prodau waualy lot. agter wih obrawal oy Huge ee blood . ohm oytern ecominadon Nuealy ro abnor malibeyTrou'sioval dingwors : Benign oa O} proxate wth fothetes (4 vba» Aiggereatiol diagno rs TRP .Se fantfowlans o He Patient ° | Age 36 sts Goa. Male Rewigroun - Wlaw Movtdal totus Mo : Decupatron : Latenes Addr Heumoxgat pur Sava, Drake dake oF aduawion +13 708-202! Hore o enamivation - 14709" 202) Beal numbes * 507 Ward male sug word froserting? comptaxnts - Le Patn dn the, anound tre umbilies for S days >, owning ir atime ir adays tustory 4 power WUnes * Aerovelng) fo stakemnene patient pack, ‘Then he aeveLopea suai unbilioas whith Wor cowtant (wo wight Woe fous + m ps hos he was seaso vorly den SINEAE pen onourd dhe an nature » Whati> yoWUh 00s swadiatt outing OF suieny etter. Volith Wy, More pedeatia» Pain was associated ne oO vor pillow, vith vomi Cy a7watoniols «KL pain ab aso He oso complasneck ° and down't contan any gor dant Www ares yes a d yrons Wack wrchwas nus ened by game type % pain aoout my dome medline He & noudabere , uo fay posit wie | wamatc His how nd bladde, Yobit L vormal | and von as! | He got qdvutled, tudo Eran medical eoVLeye a bossa | ye ery bratment . assovial | Huston 4 past {Une , He didn't Suffer ar] wgnipieaw Proview th fe pot . medical ancl wang cat. Frawily Hastory He ~ lives wth he fathes pmo WI are two Chilelaen , AU ase heat . Pesronat vic 7 god oennomee Condition *, he comes, iron muddle ass bonny , dit. vormal diet allergy no blenge seattion | addithion | nbn gmoker ) Mon aleonole . ocean At so 4nre sand rent a a a| Genera Caomivation °, | Appeasavace ~U Lootsing) | Body build. — average Mopration taoperoie Recuotry . on vnorew Nubitroal stabs’ Welk nawuthed fraema : abyent Toundiie - aboot Cyovor’ _ absent Uy bbq. Abeet Kellomyilaca absent Aeubangdnas * Qbytak dedema > Absent Aebyduanon » abyeat fulye 70 beats / ain Bwod presare 130/40 mm Ka bunuperature 4 gare Repivator date’ jar breatls [evn Lignapln wale 7 not orparle Hyver, y, not prpablea Lorak etaminat‘on « | | Tesprton« Sete o abolornen * ovord. Shape mo vernent % Cbdoven with srerpinad on *, Aledominal, thorane muse joes 2 alwenr * eae mura. absent eugorged pun Abvent Uilible qwoeLling abtent SO, Wark s Abyent . Patpation . Supertycian Patpation . -Ablclomen opt ~ v0 spoucal tonbonnery pase ou parpatn - - Me burney's pant tendennen > pasert | - kubourd Ernclesnes sabbuent - Proas sign 9 abosent - Obtwrator wey 2 Ohveat im ppetin dent (ao On eee ele 4 ot a Abyent Po,cuswion > PPA orden of Uvex dutinen = Sth dates costal ipace Feneuseion node > tyre “opude n . Astulttation ~ Bowsek Gourd aiveny DRE. Hut done Systenvie enamirnah'on + 1 Retivatog sytteen: apa : Share 5 Chest © nowmat Movernent 4 Roy irahien ot uiatedeo Pattern a respivabion NommaL amy ayoydy *, abyent any uredole wen » abut a ostble vein *, absunt vidibie pulration ~ Absant Loh » Bbbsent pigmestation 1 abet Paspation . . nec + coal paar Po sthion oF bra - , portion fer" peat ne 5" inrexcose spare" “ pm Chovioaian URE OOM ver mb Uae vocal gyemus pores acon OF crest + worm al «normal movement 64, unest ony eyes goun “1 4 beakPescusvion *, Noval pustuslatren norma |, stom ' No Ab normalities bound . Carcliovas ula Nesvous wystern «No dorormalitie, Cabient yn 4 Mav. Arepat Rahman , 36 J8 MA former hailing brow, ur. aver, Dhaka was adnut fed hm xd hospreay oy on (3-08 - 2024 0 Wh Complarnts of rudder severe pun AnoUacL UrwriLicus, hin Wak ghHteol Tut Hee trit Lowes, Aedlomen from 45 day’ - Tn pon Way wrsttnt ih patwe no saan or reuanna at © feln alse OAoUahe vot'th yoratting vhibh Was, se mon (illLoug pra aesrt — ontaun awy feed * Pain wes arvociated bath lwo aad fee He also cpg, seen % Som op o Pain Ie2urt hash wohueh wey nn sone medrerny Asthmalce , He, Dladdom ond bow hattt <¢ Normar . On Af fenetad enameahon He wer 18 noamotinne » von Aisvekte , | AU prndsigs Oke nore. on bocay eHaminahon ,Chdomen Us me Re MO ese ana pe 4d fendenen 24 pretert othe, pe dtaominad eagmination mac aosmat f Aeclal — ¢oamlnatn ud done, | . | Prouftonl apes . Recurrent pparautisDipperertiod Aagvovs, + | 9 Regt ureteric atone | 2 lypregraenitis | 4 fae lees cliseare 4 Unonie Uno eystites \nvetgahor ‘ ieee aaa ; L Cong tt Glovd sount - ESR sprit ine: - Wane RINIE - RBS - Soum oreatinene - USK % whol, alodomey ~+ kB aunt Kona towpirrnato drogners : Recurrent oppeevils Gyokwunk *. apprttectony jour apmi y ' ! | | Name. Mst. Nasein Akter [Age Us yeas | bex + Feyrate Reiaion Wan Beeupation . Howserei ge Monital &tatus , Masnied Addyex : Bank Colony, Lavan, Duaka Lote 4 admusiow’, 11 /09)2021 ate ercimination » | 9 /¥04/ 2021 Bed number. 307 Ward > Surgery female wand Chics complet, : 1, Lump in the signt beast jor eae a aVichaagng Ulces over lama je (ast 5 mouths & Pon i last | month History 4 Present Une - Aeordieg bo a Bateyment 04 tater bhe was seasovably vat oS bask , atid then yuddenly vhe nobced o lump he ou si quadsont q hm beast hile bathing . ‘Be lump woos tating gall th sige but Grocuadly fueased tn sre involving the nipple and orwola ond ulceration of ouerkyin akin ” ast B monty. ‘Tha ulcer was Sadually spreading poss wth atowly’ foul Peery olson ge saith vias sonnetinnts bfood stand\, - in in the lurmp fo (ast Lon bea sont alse jaineA wy pain > The patient compl aie Pee oggravated cytome 4 voting . ne was ue mare] “yy | wos ontinuous dull ochin owe hold work, ond xelieurd Asiodated per and Trauma . | . fa ni wtigut Love. he did yh Te pret also gr a Wivto o Haniffeant 25 ‘ht “ee ge Wietory oy vie lunep . Hho hae no eal 4 tw i herpes is » maleno, ‘jpuvelice or bone pen. Hey bowel Our0l blade habily oe ormal . With these Conaptcuint, the gt duel ad mutter, 4 im te Hunger wards 1 EMH har pete, wrovagement History %, Pose TMnen * Tere is no Wstoe 4 trauma ov other dun J 34 a the breaxt . AA OF ony other Chronic disease. The patient 4 Vormolansive , non ciaedé Ot wurroundiy, aud NON Cobhmatie Farni history : She tay $ sors ond all were laxeort fed,» Oy . bas ne bonsly story % my Woh disease | ce Porson History -, She ix non ~gmoker , nor Aheoholie, Meashual lnivry » Pak Are hes ner mal menshuak eye age 4 menouthe + Wye, Menshugl eye . 99d 2daw Mlershuok povioa . US claus Lp + 02.9, 2021an Dra History a 7 Patient ju hictory 4 big oral corte pits po! Years . Sorin - economic Ian We belongs ® ast L0-15 a too rmidde Blass gem \wmuniption Wstory 1, We & net 4g Sernmmange as pu EPI sUndule General Enarnivation Appearance Yale, wu ooking) Booty rullh Avevage Cooperation toopesative che curs’ on Unoice Nubition . auenog! Arownca . Jouvdve « abent Cyaror's abseat Cia teetrg abeor Kailonyur * absent Auatomy dave ‘bud ddryda oon 1 dbsat Ordeme « abyat fa yun “obeor fuse BY min ood, prem + (G0) 70. May for poutwe eT 43°F Respirators poke 14 (emince Haynie noes », Right along od syne cloviculas mph odes ae oth won tender, papa. hy ang 6 10 num ae 37 lam U4)Gypteenic Gaomination * | Lotak encmnination my tae Breast. Vwspeeion 2 ig wo vii tat Josanst'. Us vormat to porition ond appeasanee Tae aw Ca vn Lege breast. Nipple Grol antola ars voarn ak Rigu lanvost UE iy hag Qnd peadubous . A omgy visiole (ump A pacsert 0 upp owes ——————_—_—_ " entaigea in Corupanison to lept Oe Quadsant of Hy haeast whith cs Appor . SxUem wae od inasgual in sage < Thsse y Wleeration op tu nealing shin pth fret retin j bod stained olischoiy There & puchering a the susroundin Sun th pensra = ovay apparance WBE athyoetion % | Grd wiprle md Le 23 rt Ord Wee below de — level, oy Cyt Wpple - The ay asta i, rracked ond. pomud . Thee & WO engened vases os ony Othe, ecrematous change 1h bavaat Patpatton : Koco demperature : Rouse Terdeuen : pocseat Lume S On pad st Was tn inbsa monnnntyy lunge >the Lipper outes Quadienk my right breast OPPOY SKY Cm in ciye uth sive guts sunfece ord iM dafrned margin , bond ‘0 , consteny tnd {wr jem Urclertuiig shuchres fai d fo r fe ag bebe TY fred © weyag ty| | | Weerob'on 4 re skin unth pou cave | Oppeoreinee . | Provivonal Magerosis . | Aigpereation Mog, 7 7 \ 4 [my ve ips eer when dig Seward, sfn0 incall Woe nipple and are cla, onol ulceranén The lceratdt 8} ov skin pos pointes vay . Th pret couptined. op porn for Tron | Whith ag—o was dull aun: in nahite , Ret 04 ho history op a | associoced fue. he gave rectory oh, Hampfeont vem Loe , 1 Mrs has ne wistery 9 chet pun 1 hemophyas smalena joundaes. a Ov bone Ve Qhe has no AUevont yan Wistory , a On generad enamination , re was, wily avaud jn tefeue » And non esd edematous, AU vitals a usthn nowmal range . Rae aoa and rupradaviothas Lywaph nocles on pupae One @ Ove loted — enaumivation % breast, Riger Aorreast is, waged ealangoh and per auous, A viilde bercles Nunap 4% Present in the “pes cuter — quodsont oy breast hic, iy apprg BX cm iy nye avd “vanegulon iv drape, hord in Com cavtene Ont te from und eying sucka but fred to ovtrding SKA Thane ‘J Ylood slaned Tea « The ovoundrg Glan hes Pema Peau-ol- orange, Filoredenoma Fiore oyshie Absecon i w ww wi wi dio een, wi w i uJ vya | Investigation . for Atognors . PNAC yom lump for Sepia 7 4 Unost ara PIA view 7 Uh O whol avdowen > Bone stan 2 FF for Pete yatia assesment *, a Wood, fp" Hey, TC, De, ESR 9 Hooa eng owl Kh typing 7 Random blood sagas FS. creatinine wea 9 Une UNE 4 Ub Bra > oc aren dragors y larenome % sujiak Perea sage TL b Fatakeent ° Neo ad vuent chernw- Hoerapy Suyeleh , prowed ba mocuinda | padiod raat kom dvd then 3 eyes oy adpu rent Chemotherayy ters ween ord hosmone b therapy " neceptoa Sedu, pout. | Follow of = Hato - Exancrnaties - eh id Nh ee ded WIPartioulors Oh Patient Name. Enamul Haque Ages 30.yrans Gea. Male Religion «awe Monitoh Hak, . Manned Occupation * gannnes Addaws Qari, Savas ohake oy * Qdmusson 29-04 202! Ajokt OY ertarninahon , 24+ 04. 2025 Caled covplivas 3 Poin i leg doin for 21 days J Bae fo 2h ag | 3 Yellow coloration a tye ond Shin py Same OLUAAMNGn | History of Present SUnes » ‘According to Stalernent § de potieat , Ke wos suaigonably ou aes back « Tan he saa cleebopted pean 4 neat Upper sladomen sbich von “Ds biog fa matuae , yiaddlahhy to | tock 0 009) nde 94 est. a qgmuated 4 bry (20d anh | srolavied bs mecUtation , osmciated wrth nausta and ocavonat voting Thom i ivory of fev Tatenmntttertly vik Chilis and wegor acta attack op pow Last Jmontee, Abieh Cubnded yon festennt Foti conplans 2 yeaa’| Gistoleration of eyes chin aud wine for last 2h of The onset % a auras was fc by on asack % 5 | Yours cliscotoration was increaving in Leal indet ally but during last one week — intent u Beatrice . Pabent compen v teeny OU oves Ye booty we paseg ty colomd tool p04 Same curser He has no wed, Autalud Woo Bans bustin Hegow ve wey eae patton, sseiyut Corr, Chua! peut ae Map heneophs oe eee o Aumeteme is Nt has no H/0 DM) WIN, Asoat yeast, asioma, TE. Personal Wustor Podient von Snolen , non aleohsLe , no ta 7 using 5 Ki i vag Imomonisatn udory * ; nok fremmumnigedk Aecaehieg by EPL rd not tmnuary dk aganst nBv , Qovioeromomic ow hey i He Gttougs te 4 wade clay bowse oud OUdnks tube wey sates y fen nab . AU Dtve members age mney good heeutt, Prag ws He took owe doug bem quack bck (ene Coded Name then. ve" ) Uves 1 wend palcka Ube Sauter (hitng| General Paomination « Appearomve « TU bookiag/ body BUI auvaerge eae towpbrahie Decubitus ~ On Uae Nuduttonal Stati, - purag. Araernca. » aVenage Toundue t44 Crows” absent Koibowsdlua “ Obent ~ abant Untenyird + absent (hema. Prtstnk Oeadratien frum Pulse 102 (min Onublatg rS} ©, n Tempore cml Wood prcsrt 130120 mm ag Tena: brent vd padpiots Lele «vat pup ¢ Nbodorinal eromination : \wspection a te 2 Atagheca, Wovirnent vet suspiration 1 bbdemno thove ce umbilicw, © tenkady placed ) averted | CIT jutted= — | Strath mark . Present aU ove abdomen | No seas maak eases vin, viv'ble face , pullners ‘ rigut Wgpothonol uu, | Padget; | Temperahae : wal saved Fendennes + won teacles No (rigatole Wass, MMO, psn oO aes esther MN yo | Ue, “Pen iam UB > wot payptote ‘Tymmpance 1 Petre -pullmen luca dou, Conk “ny Aunts Alrent Vertasrion Bowel gourd puat DRE .. Revealed M0 dbnovmakity 5 Nervous, System ertamimation No Abnarmauher Respoadory tyitem examination + Rwaled uo abnowmaliner _ C¥s tamination > Revoked ws bretals hex Sabie fertwes +. Ma. Evomul Hogue 130 Years od . Hows Amaro Sauer admitted to Emon uh Comrptaraty, ag wi right vole Iypochondbes um fn hich Coed in renee radiatig to back tm ragnt ade op chest aaggrtvatea wi us C£ELEEEEEF ESTES mdyum aud, i| - | a | jan food > ome relieved DY medication | arsociated rth nanieg and otasional vorativg Tene & or oy jee an) with chi, and igen the pain whwded uh use o, — paracélona, Patient Complains yell discoloration 2 eer, Skin ard Udine je lost A daw. , The onsek ) jouvdica won presse by attack, oyun » (Ulow discetoratin Wau Toemowy th intenst Tomi itil) | but dats last one wee ta inteastly & Sens Patient Complain a ‘itdnag BL ov Lhe body ond pisses oy toloursd stool for Some duration He tas yo history % al mood Wonuuiion . és povoel- Bade habit 45 norma He gave no peal 5 wotaknes pres, wulgnt o% | chest pun. tough, hemoptyss, bane puro» hematemests . AU thts members ate wu, On Jreres examination patient 2s TU Looking > duenage lock built dnd nutv'tion cooperate » Pulse 102 /imin - BP. 130/90 ae RR din , Femnperctwas (00°F , fatient & sev ecto bat vot anaemm . Strath mark parent Al, Over Chest aud aledomen . On abdominat eamination - abdomen Seapine Hapa, umbious Us noma . Oy papatran tendons , no prtpeiole wens ) tempaatuse loamol , ror . Nuapha's wn meyatia 2 ho Orgono mealig . Tyrmpance Ov PeIcUsA'en avd Woorel youl pert » DRE sets uo ‘enorme . Oho 7 syst, LpowminahM —rovtaly voamar uyProvivibnab lagenors * Obsruche Joundies dee ty | igprentiah anger ° Perioneg ular ta Cu head oy Paweentas Investigations ie for Uagnors He 6G WhOLL Abdomen Us fore test Roukine *. CBE Londowr Boad Sugan G. Oveatinine Chest yee £4 Urike RUG "es ne Con pir nwatony dLtagmows ~ Obdtru thie Toun dee ou to Chole clo colt ey Chola cysmctorig, woth, Unrlectoce Lr Hrofo mg wot, T tue fate aeatment +Parkoulars oy the ee Name = Gewel Rana ' Age - 60 yroms \ Kea. Make Revigion. stam Oceupahon Atneleb Manilal status . Mawied Address. Avnulia Rake ov, Adewiston 03.10 .202! Date 9, Enamination : ou 10.202! Bed number» 506 WOR". Sungerg wale vind Ones Lomplants . 2. Pain tn west upper aledomen for 5 month, ik Vorniting: or 5 eos, >: Lume ” upp abdomen 524 Z months . Wastoy % powirt inen Accovdiey 0 statement of, pabent , Me vom reavonaloly bock. Tn he developed wv tn Upper Abdomen ushsin GB tmtfnous , dul ade tb) nature ogg ated, by eating , net : . yene relied y autandls Auk relieved lg ea . fain 3 ymot otgoiaktd unt 1 US vl | Ww ore % wi rp lost 5 montla - occurs e odwost dail in lor U inthe, . Vows ting peu cout Cd pul B months youA \J how, Pech , ech Lh nature ) foul wetting? oan fe | whitish in colar cantedin’ng both Aled ord unineiieg Of Hn We Complains % best. 4 10ULng wos up pes Ahdome, ; | 7 i - bo: lg “any ak pets Cogn | tm apc jond igufjeort welgut Lo% about si a hy Peres rejue ip Last Shee wwontlrs. No se q repue Ween oLiseare i" post and no Witery % vonating out oO Wood or passage } j book t stool . He has no H/D Jaundice , oust fun, | Porn snug Hu, bowel ord badder ee [History oj past Sunen : He ras ne ad b 2 ee ee = hart ¢% norxma t HID DN, MIN , heat disease as ma, 8 | Pewoual biabry - Rodent & nom WUOKes now ¥ altoheli Varna tasty We aot trmunged “wing to EPL sthedele Souo-ecavonic. tastorys. i He below, to a nail clam fant, . Lies 7 & He-pakks ig howe ond divinks tube welt fates, uses “cavitary Ldsbring | Farwy hastory AU membed Min famecly aoe Yong Goo Malth , Drug Wi Ale took sore “tablets, from boca FMaK out Count of mention the names . ‘es | 50yo OO General Enamination « Appeananee Avdow, and iu woot [Boy pualtt, Avwage | Yon - Cooperate | Aegubrtus, 5 waa | Nabublowar Status", Blow average Anaemia > + | Joundioe dlovent Cyawors ~ alotok | Rare, Cuong ~ aboent | Keilonyelud + obent + aborent Pulse 78 main Rood Prone * 180/20 mm 4 | Reapinatnay rate , (/mio ‘Tempahe . age Dedena* abeent Derydratren + pnesen | | Tnynna vol paryable | | lywphredles ° spvecaicuon lop nodes palpate Apdorninak. Enornivation * | \wspeckion : | Shape» Seaghon ] Fulnes in upp Abele men . flbcominod thonacre auspaation , umbsens, centrally placed xsaute » Mo stay mank , suiatth Mark, ergo ae ven |Raspation «, | Vampenalane who nol sare | Tondemen Fanaer in “igerovuen | No mule guna. | Lap There i On tara aod ommrerl luna ‘ | gio. epigastric aneg'on | ee ann about 5X bum | Surgree i ae rree-ol Verges wongtn HU. clean Convliten cy "Mu vow Pwratie 4 MOU uth sepisohas pvt pied unt oven skin or vein tlunchow Vue, spleen Kidney, OR Snot prlpriole , Sute usion saa Pauet Percussion : Eymmptnie , luc Lav ane, apy AuLllner clvent _ Auscuutation +. Bowe eund present OLE. Leyte wo Obnowmali nes Newous wpe". nfo Gbmonmaliti eg kopany Byvttm No abenosmeites Cards ves culas pen + Klo. aomarmalti eg IsSauitot Feattare , Me. Jewel Kona | 6O.gas oleh Mewed man , HONSMOKE nom aLCohoLe , vow Alabth'e yon hyperktarsie., ral yom Athulra, adwiitteot LOMCy var toraglaints 4 pein ww upper abdomen Continuous dul, iy vow, aggravated 4 tang pmol AeLewed ny cntaclds bu sebitveet by aaa Yer aca Met Arsocidtoet woth fee ra ey Ord rayon. He also Conqlanes Hy vowing alse dally por almotl U months . tombe a pers Wn vane, foul weld ywows to yatune ay wastes WW coos. He towspians % neury WD masy in we upper Ahelo men ‘aungis aya mol peste Cones 4 low a apehle rok sates weit los About I/st oy previous wugnt. slo Witory PUD > port and mo HO voruting ood o& passage % black meyer He has no H/d jaundite , Chest re, bone ach: tough . On L eaomibation, he ts anaious, IU tooling , Pulse 79/ rnin, Be [30/90 , nvsmal, 1 dehydrateat and no tdema . He is waildly andere, won ecteric A a eocame open png > Mao Magness On oladowinad examination aloctornen i etaphord shaped fuluners 0} a asain uunbel Lies 8s eenbvedty places Or palpanon , fenperarure & vonmat , teclesnen ee ite. Tw UW petpawe mans ia egigaatrtum about 5X6Um iamieg ater fuajace , Mdeyned m 7 orl consitenty , Now pusatile, mous WIth cxeapinarh on og wat (ed we Gompanct om percivitin Cnet boweh sound prot. DRE serals uo obwarmaLihe+ Othe system edminghar Us vorval 5Bi i i asic Cull ; oo Provitonal Dlagnors ” Gosbic et obsbuchén dt Coie Aipfambat Dingo : 00 alue [yore Atenove, 4 lavesttgabén a. UVa function wis + S4PT, ALP, PC ,c brlinubrn 2 Ue WA 3. Chest ad Rouhne * 03C os aa chrotyto | 2 Une (ME 5 Random blood nagan > Soebnre 4 £06 | > VbSAG | Tart | «Comsesuarbia- NPO | = NG sulboo | = Tu pubs - Aabkiotes | Susgery : Lagerotomy {eHowed by lowes poabac g ostre ttorng. uns sagen) \Toaticulans 9, the Pationt Nome Malmud Rastive 3 . 0 years ma’ Nate Rei ion bla Occupation Buxivemvvan Manital Status Marued Addae : Quade Bazan, Saver ate Adminton - gr 09-4.202 ! ate oy Examination’ 09-9 2024 Bed number © 307 Ward» Summery make voard Cnig Conplaiuts 5 4. Pain in vepes aibclownein jor Bytons ee oat ae bwontg Uslorg o, present funws’. Aecording tv statement q the en he aanoya necusient attacks oF iW nats, , hon - naalading , eating « Patient patient he war vuasonably wu 6 yeas book . TW poem app Alndomen ain B burning aggravated. in -enngty gtowatlh and selevect bad sfunilan atta pan ‘vitiolly yer 23 moutre with ye hae CC a monty . Thin he took tore wo Uy wnecli Cine fond. tobrel ad boat panera a But 55EF re last broutth potiut Us vovig fovstant pain ‘Pain g | auodated with vovatting jor wer brvovily | He Utd by onus 2-3 tines daily » way ducing evening sometimes Ayter tig meal rpropetite Fn volute opts th amount ,vortu, (tn poatic digested hoes even couterit, 4 23 dap begone ; geleawetitn spout wantlliver aud 4g 9 UK in taste ane causing cousidenable nig and bin become muvag aga there was waster oy Puducea vonaiting) » He hat wo sory % | low ci Sea 1 abelomen, pus eeiea te back as te Sroutdea . Hs ouel and badder habit i voamal: Wis bony % past Wnes, Ste has vo Wishvay a5 lab, meliites , hapertersion ; hear disease ,uthma, tuberculovs Persoval vistory Patient i von emoken Yen alcolneled Im nunizahion story ; He i iwnmunined according dy the EP! schedule ond ot linn ea ia Hepatitis B fem) Wien: MM wis Jy wns em 3 ged ata| | | | Genorat Exomwvahon : oo Appearance + Qnauiour ,iULLacks nap Body bulla . owerage Loopenatiin . BOL ve Weubitus: on Uneve Nubuttoo below average. Avena s+ Toundice : absent | Gyonons absent Clubbing Abeent Kotlona chia * Alosent leukonyonca 1 Oleent Pulse > 79 mio Blwod prewure ~ 130/90 wm 4 Tonpesatas : 48°F Respiaetony Rate 14 /rmoute Ordema. — absent adehydrration - porvert “Thyrova . viol parpable Lymph ard : va ee Abdominal examination * bes ee Sage: Seaplane Full news vn ae Aledo men woververl with vespinahion ~) Obdowing Horacte Umbilius, terminally placed, mueled,No stax mark seratch mark , engaaged vein . fr Yon *, | Tempoature | NOt voused | Kevilennes . tencle operon | vio poponie mous, a rruels guard 105 myperesthe ni is spleen , Walneg , sina biaddes . vol palpate Percussion « “Tyrporie Fludd Youll , 1 Bighing dullnen abent | Auseuatin * Bowel youd present DRE* reveals vo Cees Navan waters enomeatisn = Revaled no obrosmali he Conrciovarulas yynern enannahon * Revealed 16 alonoamalibes | eran systen + Revealed 10 abnosmaistyes Sabiont Fectune - M4» Malmud Kawi ,U0 year old Movued wan , non moles hon alcove ron daloetee” | non hagperteauave butinemay hui your (endo Bareu, Savon wos admitted to CM Cr mj tonglound, OF ecu olodomuie pun ia UPpEA _edbetonen nde Cried nade sr” nad 1 Aggravated in Howath . 7 ond seleives, by tateg. Patent adl sronekan wot, poor gee Catesual Oh Olan SU months . then he — took yome milly redline and -Lobtet Kr vorat ph st On moest au esBut ie last vows pahert & bon toustod On» tan 15, assovated wth vomitin jor (ask brant. Ho wre to wrt yu, 2-Shmey douly propehe Yur natwe » Lopiow 1h oe , me onnially alg digested, jou content 1 yuan, eye oa Ona 4yotey ; os Yo taste ond using nl Basjs He las uo Ws lo ovdon 4. w tong O Lew 4 oposite Nurep im abeAcwes pose ct to back, Wis badder Oud bower nayd % + Wosmal . On general enownination he Uy amiour, iL Lwokiing 2 copesatid oon vutbubenal status, pulse 78lwin ;BP HEtT 130/20 mm xq , Re IU ime tenagescdine vrowmat, dehydnarre ond no edema. , He Us waldlyy anemia non edlerie 1 Meligeaphaslenayaty 1 Hegpomagaly Ouabdonural eaammad’n’, dlodowen Uy are thoye spulnes % eee umbiLices O central plated , no stow mark ) 0 guatuh moak . Dr payansn fenpbratus vosrat, tendesnes vo the ee 4M palpate moss no oagavornegay ) weston , “ype on pencunion , oma lopwel yourd poe _ ORE potas wo alonosmaline, . Othe Systems Oy nose , Paourvional Magno ss *, Gasbue outlet dbstwchin die Pylore Arnon, Aifjoutisl diignors - Gasbre outlet obyruthin clue ho Co stomach ; is\nvestiqat'on Cos diagreys . Endoveoty % pen qit Onel biopory | fouhnie : 3. CBC ash Checlrotyte 3. Unre 6E we. ROS s C. (rane 6. Chost ae a1. &CG 2. HOSAG Ara neeent Consenvatre 9 NPO 3 N6 suit 3 BV fucd oreo saline 3 avdlofoe Sogn B Lateral trucal vagoto a ago m4 (Ty) wth Grstesyy une som .farboulars 9 Hu Pabent : Nowe Mohammed Umail Age 30 Six: Male gion - law Occupation Fasmes, Mossel Satiy . mevuwed Addnes. Agnulca & abe 5 aduntwion . 20:05. 2021 Late % Enarmivahen . 30. 09- 202! Bed numbes 503 Wana « Susgery male ward - City covapaiuts i" 2+ Poin iw Let Mg yr wi 2. Yai obislervo sation o% ought Qaread toe fpr 2m, , Histo a, Prusent sagertion. 3Unes Aeconding to Gakemnert the pore. he wos, neasonaroly wet 1 yw botk Ther he grade developed pain th Uehe cat negion whi Comping iv netwe , not preset Sn the guest she and lbsougd on grecluctly by wanting Lica one puivedl by seshing fold (outa continue by waitk despite dhe pain . Astance aytes Whirl pose appeers eas S| reduatiy ond aol w tae,Set wWrone Brequenty Fon (asd one month , be Ad hung Continuous dua aaa) poze w his lege fet hey ds ures Ws seep ond is sekieved by teapng Leg buow the 6, About 2 monly lack We vaob'cen jraduas black, Ailey 4 lett reat hoe vohith ix Aswouakeol uth conchant uu, auning Poun . Ws othe Limb nas io Cansplain(s He hes na wustoay 4 chest 0%" > unaig Sh VION | ath out oF Femuay a aaa WS bowel ord bladder habit & normal . aa Oh past Une. We ice, na wistony oy OM UTN Weart As ease » thio fuberctos, Personal watery + Patiert is o Uneuin vnroken lang 20 SHU pou 20 dteres “He & non alechetic _ He wk, hare sroted. Imnounigation ee Hot imu nae eas) to Ef) whedut, Forni Waston : AU uty janety Menoers axe “yun geod heath . i nite © WOK Somme legs bud coulalne name ther General Paciminah’n - Appearance 1 Ava‘ous Body bwu * Average Conpmation - ee oecubitas On UnniceNutone eats | A Average Jaundice Absent Avenue - dosent Pat Clubbing : abet Keibonydnin > absent eukonyuria ° abeat Cyanors », aber Pulse” [gaia BP. 130 (80 mmm Key Tempuratuse * (00°F Regioratony ae” td Ima Oedema *» absent pao vot palpaele Lymph node not payane . | Local eaamivation Inspection Rignt Meg yore + Vat uy viaki aiscolovatien »gangnenes vg: parparion [2 tengenanae - Lowe fn ley 4 up 0 ty vr (aly HEGIOM 2 tendeanus — wild antoua dasa pe 4 ontertos | oy antuulal pusraton 5 AGCAL Oud poten bran > aloert poputeal ond yerorat ~ present radio - ,urmora dleloy = abo 63————_—_—___———— » pain and tout sensation . prentn ™ t | 4 jerks + norma | . ation + | Systeme eran | evs | tmpection 2 normal | he peepation + ; open beat in Lege 5 Wben Coser | Hite 4 om pa Vo Pepeoy duseullation . $5 %S, aucuble wv all auscufta tory aq wider, No poner -steanar Veave | no added sound dA NO muamug Nowvous system Vamivation + Moton Sypitm enamivnnatton . Nash ond jascitulabion < abyent Buu % mucle - horma fone Bie normac power % mun », normat Voted * Rormat era Normat Fe / J as noAmal out + 4 t Normat . Sensory enOminet'on » yin and truth geagaber ab novelAbdominal. enarmmation: Reyeawead no abnosmay ies Resinetony enaminatian ', Rewalel no abvoarvatitur | Gobient Features ° [vir. Mokormed Utell 30 yecr old, mawuea muslin , non - | atcolreic , non + diabetes y noo tanvve 1 Maing prom Adnulica admitled bo EMH vals the COmplaviats OY Lebe aauly megron pun The pain “a cramping fn ge nate , vot paver tn dhe. yest a aud brought On greduaiy ig} wading Lk ork gelived by nesting but could conbnue we walk espe we pers Distance afta Lohich pain appeaws wat deereasrng gredually and had t take mor more yequets: Fon (ast one monty , he % Gauri Continuous dull cal pain, va his gt foot volucn duskurbs Wis Weep and i Aekuived ty beep bey oon te bed . 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