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34 year old male with vomiting, hiccups and cough.

Roll no. 103




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 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 jaundice, was diagnosed with alcoholic liver disease.
---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.

Personal History 
Diet- mixed 
Appetite- decreased 
Bowel and bladder- regular 
Sleep- regular 
Addictions-
chronic alcoholic since 16years 
Alcohol(beer) since 16 yrs daily 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.

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-16/min
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 


Investigations- LFT
 

Serum electrolytes 
 



Blood urea 

 
Serum creatinine 


Other investigations
Haemogram
Cue
Echo
ECG 
Chest xray 
 


Provisional diagnosis 

Alcoholic liver disease ?
Hyponatremia associated with hiccups?


Treatment-
 IVF-0.9% NS @ 100 ml / hr
RL@100 ml/ hr
Inj. Pantop 40 mg I/v Od 
Tab baclofen 10 mg
Inj zofer 4 mg Iv TID
Inj thiamine
Inj metoclopromide
Syp lactulose
Strict I/o charting 

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