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8/14/2019 An Interesting Case of ? (Abdominal Angina)
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Case 2
An Interesting Case of
? (Abdominal Angina)
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HISTORY
Name - > Ms Pooja Ratawal
Age - > 20 yrs
education -> Graduate
Occupation - > Primary School
Teacher
Unmarried
Resident of Delhi
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CHIEF COMPLAINTS
Patient was admitted in
medical emergency on 12th
April 2009 with chiefcomplaints of ->
1. Abdominal pain for 2 days
2. Vomiting for 2 days
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PROGRESS
Patient was normal 2 days backwhen she developed->
Abdominal pain, colicky in
nature, persistent throughoutthe day, aggravated by food
intake, not referred or radiating
to any other siteVomiting, worsened by food
intake, Non bilious
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Progress (Contd....)
1 episode of malena No dysphagia, GERD, hemetemesis
and bowel complaints
No h/o fever, rash or bleeding fromany other site
No history suggestive of
respiratory or cardiac illness No history of urinary bladder
disturbances
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Progress (Contd....)
No history of renal/ureteric colic
No h/o worms in stools
No history suggestive ofjaundice or liver cell failure
No h/o abdominal distension
No other significant complaints
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Past history
Patient was admitted to SRGH 2days before admission for abdominalpain and was investigated there.
She was diagnosed as acutepancreatitis ( amylase 346 ) andreferred to our hospital for economicreasons
No past history of similarcomplaints, tuberculosis, NSAIDintake or jaundice.
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Personal History
Non smoker
No h/o alcohol intake.
Vegetarian
Normal sleep cycle
No h/o appetite loss
No h/o bladder or boweldisturbance
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Menstrual history
Patient has a normal menstrual
history and is unmarried
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GPE (Patient was.....)
Conscious, co-operative and welloriented
she was of small build with a BMI of 18
Temperature was normal
Pulse (92/min in L radial artery withnormal force & volume)
Pulse was feeble in right brachial and
radial arteries. All other pulses werenormal
RR was 18/Min
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GPE (Contd....)
Blood pressure100/60 in left upper limb70 mm hg systolic in right upper limb118/76 in both lower limbs
No clubbing, cyanosis, icterus, orpedal edema
JVP not raised
No Palpable Lns
Skin, Back and Spine was normal
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Systemic examination
ABDOMINAL EXAMINATION
Soft, non-tender
Liver 2 cm below costal marginnon tender with smooth surface andregular margins
Spleen 1 cm below costal margin
No free fluid in abdomen
Bowel sounds - > normal
No abdominal bruit
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INVESTIGATIONS
Haemogram :->
1. Hb 10.6
2. TLC 9800 ( P72L27E1)3. PLC 1.7 Lacs
4. Esr 7
5. MP neg.
6. Peripheral smear normal
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Inv. Contd..
Liver function as well as renal
function tests were normal
Serum amylase was 239
S. Na/k 132/4.3
S. Ca/Po4 8.6/3.4
S. Alb/Glob. 3.6/2.7
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Inv. Contd..
Urine R/M - > Normal.
X ray chest was normal.
X-ray abdomen (erect and
supine) normal.
Ultrasonographic examination
of abdomen showed hepato -
spleenomegaly with 8mm
calculus in gall bladder.
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Inv. Contd..
Endoscopic examination of
upper GI revealed fundal
gastritis
CECT abdomen revealed onlycholidocholithiasis with dilated
CBD
Colour Doppler examination ofboth upper limbs showed right
subclavian artery occlusion.
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Inv. Contd..
4 vessels angiography was
performed and it was
suggestive of 100% block inright subclavian artery along
with obstruction in inferior
mesenteric artery.
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