61 yr old female with nausea and vomitings.

Interns

Dr Supriya

Dr Mohitha

Dr Sowmya

Dr Amrutha

Dr Sanjay

Dr DurgaKrishna PGY1

Dr Ajith Kumar PGY2

Dr Laxma Reddy PGY3

Dr Manasa PGY3

Dr Vijayalaxmi Asst. prof

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61 yr old female presented on 7/3/21 to casualty with

C/o pain abdomen from yesterday,

C/o nausea and vomitings from yesterday.

Patient was apparently asymptomatic 13 yrs ago. She went to a local hospital with complaints of generalised weakness, got her routine blood work done and was diagnosed with type 2 diabetes mellitus for which she is on regular medication -Tab GLYCOMET-SR. (METFORMIN HYDROCHLORIDE SUSTAINED RELEASE)

12 yrs ago she got a hysterectomy done

i/v/o ?fibroid.

10 years ago she went to the hospital with complaints of giddiness and neck pain. She was diagnosed with hypertension and is on regular medication- Tab TELMA-AM(40/5) (TELMISARTAN 40mg+ AMLODIPINE 5mg)

3 years ago she had joints pains starting in the small joints of hands and then her knees. She went to the hospital where she was prescribed some medication(no records) which she used for 1 month.

Later on she had intermittent joint pains for which she would take some pain medication.

She also took homeopathy medication for 2 years and stopped 1 yr ago.

Around 1 yr ago she started having episodes of vomiting for which she would go to a local hospital, get admitted for a day, get medication and the vomitings would subside. Around 2 weeks later, the episodes would start again. The episodes of vomiting are non projectile, non bilious, not blood stained. Initially the episodes start off spontaneously which contain food particles and later she has the urge to vomit and she induces vomiting by using her fingers.

She has loss of appetite from 1 year.

6 months ago, she went to a hospital with complaints of vomiting, had a blood transfusion done in view of low haemoglobin levels.

3 months ago she went to a local hospital for joint pains, had some tests done(no records) and she was started on tab PREDNISOLONE and tab HYDROXYCHLOROQUINE.

Now she came with similar complaints of multiple episodes of vomitings from yesterday, non projectile, non bilious, contains food particles, not blood stained. Also self induced vomiting due to nausea. C/o pain abdomen which is insidious in onset, diffuse, squeezing type, no aggravating and relieving factors.

C/o Loss of appetite.

No h/o fever, loose stools.

No h/o pedal edema, SOB, decreased urine output.

No h/o palpitations, chest pain.

No h/o TB, Asthma,Epilepsy,thyroid disorders.

Adequate sleep.

Loss of appetite.

Mixed diet.

Regular bowel and bladder movements.

No addictions.

No known drug and food allergies.

O/E-