65 yr old with diffuse right chest pain
A 65 yr old male came to casuality with c/o diffuse chest pain and right sided abdominal pain since 4th march morning 3am
C/0 vomitings since 3rd evening
HOPI: pt was apparently asymptomatic 4day ago then he had on and off right sided abdominal pain gradually progressive not radiating to back not relieving on rest and pt also had 2 episodes of vomiting non bilious , non projectile, food as content .
Associated with chest pain which was insidious in onset gradually progressive
Squeezing type of pain .
He had similar complaints 1 year ago , treated conservatively .
Pt was chronic alcoholic from 10years ,daily he consumes 90ml/day
Last intake of alcohol - 3rd night
No H/0 of loose stools , fever , palpitations ,constipation ,burning micturition
Past history : not a k/c/o DM , HTN, Asthma, epilepsy, thyroid .
O/E: Patient is conscious ,coherent and cooperative moderately built and moderately nourished
No pallor/Icterus/Cyanosis/Clubbing/Generalised Lymphadenopathy/Pedal edema
Temp:Afebrile
PR:88 bpm
BP:140/90mm of hg
CVS:S1,S2 heard,no murmurs
RS:BAE ,NVBS heard
P/A:SOFT,Bs , Tenderness present in right hypochondrium and right lumbar region (Murfy's sign)
Usg abdomen :
cholelithiasis 2 calculi 12 mm each .
Gb wall thickened measuring 9mm
No evidence of any pericholecystic collection .
Treatment :
- NBM Till further orders
- IVF 1 NS , RL , DNS @ 75ml /hr
- Inj . TAXIM 1gm IV/bd
- Inj.Metrogyl 400mg IV tid
- Inj pan 40 mg IV od
- Inj tramodol in 100 ml ns
- Inj . Zofer 4 mg IV /od
- PR/Bp monitoring hourly
Inj pan 40 mg IV od
Inj tramodol in 100 ml ns
Inj . Zofer 4 mg IV /od
PR/Bp monitoring hourly
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