55 yr old with recurrent diarrhea

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome

 

Case discussion


A 55yr old female patient came to opd with complaints of abdominal pain,loose stools and vomitings since 10days.

Pain abdomen diffuse in nature,non radiating

Vomitings 3 episodes per day ,non projectile, contains food particles,immediately after eating,non bilious and not blood tinged.

Loose stools 3-4 episodes per day ,small in volume, watery in consistency not associated with blood

Patient was apparently asymptomatic 10years back then she developed joint paints for which she had taken NSAIDS given by the local RMP .

8yrs back she had similar complaints of pain abdomen with loose stools for which she was given symptomatic treatment (unknown medication) given by local RMP.

Inspite of  using those medications(irregualr)  for 1 year, as the symptoms did not subside ,she consulted gastroenterologist where the following investigations were done and diagnosed as acute on chronic colitis, errosive gastritis








Tab.MESACOL 1.2gm OD 
Tab.TRYPTOPHAN 25mg HS
Prescribed by the gastroenterologist 

Symptoms relieved on taking these medication and recurrence of similar symptoms due to irregular medication from past 6 years.

Incidentally pt noticed black colored stools(malena) 6yrs back.

Diagnosed as diabetes and hypothyroidism 8yrs back and on regular medication T.Glimiperide 1mg BD and T.Levothyroxine 88mg OD respectively. 

Throwing some light on her personal life 
She got married at the age of 14years and blessed with 4sons out of which 3sons were expired
1st child was a premature baby died after birth
2nd son died 3years back due to snake bite
3rd son expired 6months back due to MI
No h/o similar complaints in family 


Not a k/c/o HTN,Epilepsy,asthma,CAD,CKD.
Previous h/o blood transfusion 8yrs back.( for her anaemia)

Vitals:
Afebrile
BP - 110/80
Pulse - 84bpm
RR - 16cpm
GRBS - 126gm/dl

Pallor present ,no signs of clubbing, icterus, cyanosis, lymphadenopaty,edema.

O/e signs of dehydration present such as loss of skin turgor,dry lips and dry tongue.

RS - bae +,nvbs +,no added sounds
CVS - S1S2 heard,no murmurs
P/A - soft,tender,BS +

CNS EXAMINATION

HMF normal 

All Cranial nerves intact 

Gait - waddling gait (osteoarthritis)

Motor system:

          Bulk - normal 
          Tone- normal
          Power -normal

          Reflexes-          right               left

          Biceps                +2                 +2
          Triceps               +2                 +2
          Knee                   +2                 +2
          Ankle                  +2                  +2
          Plantar          extensor        extensor

Sensory system examination : normal

Cerebellar signs - intact

Following investigations were done:















Treatment given:


Day 1

1)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Buscopan BD
)Inj. Panto 40mg OD
4)Inj.  Zofer 4mg SOS
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) access. to sliding scale

Day 2

1)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Buscopan BD
)Inj. Panto 40mg OD
4)Inj.  Zofer 4mg SOS
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) access. to sliding scale
8)Inj.Fe & sucrose 1amp in 500 ml NS slow iv
9)Tab.Sporolac DS  TID

Day 3

Pain abdomen subside and no complaints of loose stools,no.of stools passed is only 1episode small volume & normal consistency 


1)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Tramadol BD
3)Inj. Panto 40mg OD
4)Tab. Sporolac DS/PO/TID
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) acc. to sliding scale
8)Tab. Folvite 5mg OD
9)Inj. Ciprofloxacin 500 mg BD
10)Inj. Metronidazole 100 mg TID

1unit of PRBC transfusion was done.
Present Hb - 8.9


Day 4

)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Tramadol BD
3)Inj. Panto 40mg OD
4)Tab. Sporolac DS/PO/TID
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) acc. to sliding scale
8)Tab. Folvite 5mg OD
9)Inj. Ciprofloxacin 500 mg BD
10)Inj. Metronidazole 100 mg TID




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