Case presentation

Rudhran N-111901143

AVS Keerthana reddy-111901010

Case scenario
• 34 year old male patient residing in Sriperumbudur
• Farmer by occupation
• Lower socioeconomic class
Chief complaints
• Pain in abdomen for 3 months
• Yellowish discolouration of the eye for 2 months
• Blood in stools for 15 days
History of presenting illness
• The patient was apparently normal 3 months ago after which he developed
pain in the right hypochondrium which was insidious in onset and
progressive in nature
• Sharp in nature
• Continuous type
• Not radiating
• No aggravating factors and relieves on medication
• Yellowish discolouration seen in the eyes for the past 2 months
• Which was mild, non progressive
• H/o blood in stool for past 15 days.
• H/o loss of weight
• H/o constipation
• Negative H/O:
• h/o loss of appetite
• No h/o nausea, vomiting
• No h/o hemetemesis
• No h/o fever
• No h/o chronic cough, hemoptysis
• No h/o trauma
• No h/o bone pain
• No h/o bleeding per rectum
Past history
• Not a known case of Diabetes, hypertension, asthma, tuberculosis
and epilepsy
• No h/o similar complaints in the past
• No h/o any previous surgeries
Treatment history
• No H/o gastrectomy or any bowel surgery
• No H/O chemotherapy
Personal history
• Mixed diet
• Loss of appetite for past one month
• Altered Bowel habits for past one month ( constipation)
Normal bladder movements
• Normal sleep pattern
• H/o tobacco chewing for the past 20 years
• Non smoker and non alcoholic
Family history
• No h/o similar complaints in the family
• No other co morbidities in the family
Summary
• 34 yrs male patient presented with pain abdomen since 3
months,yellowish discolouration for past one month, blood in stools
since 15 days who consumes mixed diet and tobacco chewer for the
past 20 years with altered sleep and bowel habits and loss of appetite.
General physical examination
• Patient was conscious, oriented to time place and person,
comfortable, moderately built and moderately nourished.
• Pallor present
• icterus present
• No cyanosis
• No clubbing
• No pedal edema
• No generalised lymphadenopathy.
Vitals
• Pulse rate : 88 beats per minute, regular rhythm, normal volume,
normal character, no radio radial and radio femoral delay, all
peripheral vessels felt
• It was felt in right radial artery
• Blood pressure: 110/80 in right brachial artery in supine position
• Respiratory rate: 18 breaths per minute
• Temperature: afebrile
Per abdominal examination
1)INSPECTION:
• All quadrants equally moves with respiration
• Flanks free
• Umbilicus central inverted. No nodule/ mass noted.
• No visible peristalsis or pulsations
• No dilated veins, no sinuses.
• Hernial orifices normal
• Supraclavicular fossa: no fullness
2) PALPATION:
• no warmth and tenderness.
• No hepatomegaly
• Surface-nodular
• Consistency-firm
• Lower border-felt
• Supraclavicular fossa-no fullness
3) PERCUSSION:
Liver span- 16cm
No fluid thrill
No shifting dullness,
• No evidence of free fluid.
4) AUSCULTATION :
• Bowel sounds heard.
Systemic examination

• CVS : S1,S2 heard , no murmurs

• RS: bilateral normal vesicular breath sounds heard, no added sounds
• CNS: no focal neurological deficit
Provisional diagnosis
• liver secondaries with unknown primary
Investigations
• CBC
• Urine analysis
• Coagulation profile
• LFT
• Occult blood test
• USG Abdomen