34 year old male with vomiting, hiccups and cough
A 34 year old male patient lorry driver by occupation resident of chitiyala came to opd with chief complaints of Vomiting, Hiccups and Cough since 3 days
HOPI-
Patient was apparently asymptomatic 3 days back then he had vomiting 10 episodes per day which is sudden in onset,non bilious,non projectile,food and water as the contents.
Vomiting is present immediately after food,water and alcohol intake.After vomiting he was associated with generalized weakness for which he went to local hospital and was under normal saline 3 days back.
There is history of dark stools 3 days back lasted for 1 day, which is non blood stained.
Hiccups Since 3 days continuously and associated with mild difficulty in swallowing
Cough- dry since 3 days not associated with fever sore throat cold.
Similar complaints --3 months back he had vomiting and was diagnosed with jaundice
---10 years ago he met with an accident and was in coma for 2 days.
Past History-
Not a known case of Dm,Tb, epilepsy, asthma,HTN
No h/o previous surgery
No h/o any allergy
Personal History
Diet- mixed
Appetite- decreased
Bowel and bladder- regular
Sleep- regular
Addictions-
chronic alcoholic since 16years
Alcohol since 16 yrs daily ( minimum 90 ml per day ) 3 months back he has stopped Consuming alcohol as he was diagnosed with jaundice, but 5-10days back he again started consuming alcohol.
Increased consumption during night after dinner.
Also consume tobacco in the form of gutka ( betel quid ) . Starting he used to take 1 packets, now he is taking 10 packets daily.
Family history
Not significant
General physical examination-
Patient is conscious coherent cooperative well oriented to time place and person moderately built and nourished
Pallor -absent
Icterus- absent
Cyanosis- absent
Clubbing absent
Lymphadenopathy-absent
Edema-absent
Vitals
Temperature- afebrile
RR-16cpm
PR 75bpm
BP 130/70 mm hg
Systemic examination-
Abdominal examination
On inspection :-
Abdomen flat
No distension
No engorged veins
No visible pulsations
No scars
Palpation-
All inspectory findings are confirmed in Palpation
No tenderness
No guarding rigidity
No Hepatomegaly
No splenomegaly
Percussion-
Liver span 10 cm
Auscultation-
Bowel sounds are heard
Respiratory system
Trachea is central
B/l air entry is present
Normal respiratory movements
Normal vesicular breath sounds
Cardiovascular system
S1 and S2 heard no murmurs present
CNS examination
No focal neurological deficits
Provisional diagnosis
Alcoholic liver disease
Hyponatremia with hiccups
Investigations:
LFT
1. IVF- 0.9 NS @ 100 ml/hr
RL- @ 100 ml/hr
2. Inj. Thiamine 200 mg in 100 ml NS IV/TID
3. Inj. Zofer 4 mg/ IV/ TID
4. Inj. Metoclopramide 10 mg/IV/SOS
5. Syp. Lactulose 30 ml/ PO/ HS
6. Tab. Udiliv 300 mg PO/BD
7. Inj. Vit K 20 mg IV/STAT (100 ml NS) followed by Inj. Vit K 10 mg in 100 ml NS/IV/BD
8. Syp. Mucaine gel 15 ml/PO/TID
9. Tab. PAN-D (40/30) PO/OD
10. Watch for any bleeding manifestations
11. Watch for signs of Hepatic encephalopathy
12. Strict I/O charting
13. Monitor vitals BP, PR, Temp
14. Inform SOS
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