2nd degree Paralytic lieus

SCENARIO:

A 50 year old female presented to the OPD with SOB and constipation.


COMPLAINTS AND DURATION

  • Constipation since 3 days

  • Pain in abdomen

  • Shortness of breath

  • Nausea and vomiting since 3 days
  • Pain in chest since 2 years 

HISTORY OF PRESENT ILLNESS

Patient apparently asymptomatic 2 months ago, developed shortness of breath, pain in abdomen(right side tenderness and right hypochondriac pain) and constipation.This was followed by 4 episodes of vomiting


HISTORY OF PAST ILLNESS

  • Not a K/C/O HTN, DM, asthma, epilepsy

  • Renal caliculi treated conservatively 2 years ago








TREATMENT HISTORY

No significant treatment history


PERSONAL HISTORY

  • Appetite - Normal

  • Bowels- Constipated

  • Micturition -Normal

  • No known allergies

  • No addictions


FAMILY HISTORY

  • No significant family history


MENSTRUAL HISTORY

  • Hysterectomy done 15 years ago for fibroid bodies


PHYSICAL EXAMINATION

  1. GENERAL

  • Pallor - Yes

  • Icterus - No 

  • Cyanosis - No

  • Clubbing of finger/toes - No

  • Lymphadenopathy - No

  • Oedema - No

  • Temperature - afebrile 

  • Pulse rate 70 b/min

  • Respiration rate - 17/min

  • BP 1400/80 mmHg 






SYSTEMIC EXAMINATION 

  1. CARDIOVASCULAR SYSTEM

  • Thrills - No 

  • Cardiac sounds - S1 , S2 positive


  1. RESPIRATORY SYSTEM 

  • Dysponea - No 

  • Wheeze - No

  • Position of trachea - Central 

  • Breath sounds - Vesicular  


  1. ABDOMEN

  • Shape of abdomen - Scaphoid
  • Tenderness present 
  • Palpable mass absent 
  • Liver and spleen non palpable 
  • Bowel sounds - Sluggish

  1. CENTRAL NERVOUS SYSTEM 

  • Level of consciousness 

  1. Alert

  2. Stuporous 

  • Signs of meningeal irritation

  1. Neck stiffness - no

  2. Kerning’s sign - no

  • Cranial nerves - normal 

  • Motor system - normal

  • Sensory system - normal 

  • Glasgow system - normal 

  • Cerebral signs

  1. Finger nose coordination - Yes

  2. Knee Heel In-coordination - Yes


F.MUSCULO SKELETAL SYSTEM - normal 


G. SKIN - normal

 

H. EXAMINATION OF BREAST - normal


I. EXAMINATION OF ENT - normal


J.EXAMINATION OF TEETH AND ORAL CAVITY - normal


K. EXAMINATION OF HEAD AND NECK  - normal



INVESTIGATIONS












TREATMENT

  • IV fluids
  • Soap water enema 
  • Buscopan SOS 
  • Pan D
  • Duphalac  







PROVISIONAL DIAGNOSIS/ DIAGNOSIS 

  • Constipation with 2nd degree paralytic ulcer





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