an interesting case of ? (abdominal angina)

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


3/22

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


5/22

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


7/22

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


12/22

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


15/22

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.


17/22

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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19/22

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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an interesting case of ? (abdominal angina)

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