52 year old male complaining of fever, vomitings, decreased appetite and generalised weakness

52 YEAR OLD MALE COMPLAINING OF FEVER, VOMITINGS, DECREASED APPETITE AND GENERALIZED WEAKNESS

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A 52 year old male, farmer by occupation, hailing from Chityala, presented to the OPD with chief complaints of fever and vomitings since 1 month .

History of presenting illness : The patient was apparently asymptomatic 1 month back, then he developed low-grade fever, intermittent not associated with chills and rigors .

He has history of vomitings after taking food, 2 episodes/day which is non projectile, non bilious and with food as contents.

He also has history of bilateral loin pain and lower back ache since 1 month which is non radiating and continuous.

The patient also complains of 5kg weight loss in the past 1 month.

The patient also complains of generalised weakness and decreased appetite since 20 days.

The patient also complains of dark coloured stools 3 days back, for 2 days.

The patient got a blood transfusion ( PRBC ) on 30/10/22 . He got another blood transfusion on 31/10/22 . His initial hemoglobin level was 4.9 mg/dl, after the transfusions it has now raised to 7 mg/dl . His blood group is O positive. He did not have any reactions during or after the transfusions .

Past history : No H/O  HTN, DM, epilepsy,  TB, thyroid disorders, coronary artery disease,  asthma.

Personal history  : 1 month back when the patient was alright, he used to do cotton farming from morning to evening. But now as he is ill since 1 month, he stopped farming and is now staying back at home along with his mother .

Diet ‐ mixed

Appetite ‐ decreased 

Sleep ‐ decreased 

Bowel and Bladder movements ‐ decreased

Addictions ‐ was an alcoholic ( used to consume about 90 ml alcohol/day for 10 years now) but stopped 1 month back

General Examination : The patient is conscious, coherent but non cooperative, poorly built and nourished.

Pallor is present.

Icterus, cyanosis, clubbing, pedal edema are absent.

Generalised lymphadenopathy is absent but left supraclavicular lymphadenopathy is present.

Right                                                   Left

VITALS :

31/10/22 :

Temperature - 98.6F

BP - 120/70 mm Hg

HR - 86 bpm

RR - 18 cpm

Systemic Examination  : 

CVS : 

On palpation ‐

• Apex beat was felt in the 5th intercostal space medial to the mid clavicular line. 

• JVP was normal 

• No precordial bulge 

• No parasternal heave

On auscultation ‐ S1, S2 heard , no murmurs 

RS :

On inspection  ‐

• Chest is bilaterally symmetrical 

• Expansion of chest: Equal on both sides

• Position of trachea: Central

• No visible scars, sinuses, pulsations

On palpation  : 

• Expansion of chest was equal on both sides. 

• Position of trachea: Central

• Tactile Vocal Fremitus: resonant note was felt.

On percussion: all lung areas were resonant 

On auscultation : 

• Bilateral air entry was present, normal vesicular breath sounds were heard. 

• Vocal resonance: resonant in all areas

P/A : soft, non tender, no organomegaly, no distension,  bowel sounds heard.

CNS : The patient is well oriented to time, place, person.

Higher mental functions are intact.

Cranial nerve examination :‐

All cranial nerves are intact and functioning. 

Motor System Examination :‐

• Normal bulk in upper and lower limbs

• Normal tone in upper and lower limbs

• Normal power in upper and lower limbs

• Gait is normal .

. All reflexes are normal.

Sensory System Examination :‐

Normal sensations are felt in all the dermatomes.

INVESTIGATIONS :

28/10/22 :

HEMOGRAM

FEVER CHART

CUE

USG

COLOUR DOPPLER 2D ECHO

ECG

Gastric Endoscopy video :

Provisional Diagnosis : Gastric carcinoma with left supraclavicular lymph node enlargement and anemia

Treatment :

1) Inj. Iron sucrose 100 mg in 100 ml NS IV BD

2) Inj. Zofer 4 mg IV TID

3) Tab. Baclofen 10 mg PO BD

Referred to higher centre