Case 15 - A 75 year old man with epigastrial pain and swelling

A 75 year old man with epigastrial pain and swelling.


Hi, I am R. Ramya Keerthana, 5th semester medical student. This is an online elog book to discuss our patients health data after taking their consent. This also reflects my patient centered online learning portfolio.


Case Scenario
A 75 year old man from Yadadri came to OPD on 13th of June with chief complaints of pain in the upper abdomen since 10 days.


History of Presenting Illness
- patient was apparently asymptomatic 5 years ago when he noticed a small swelling in the epigastric region which was initially painless. The swelling is sudden in onset and gradually grew to the present size. Tenderness over swelling is present.
- since 10 days ago, he developed epigastric pain which is sudden in onset, gradually progressive, intermittent, non-radiating and shooting type. Pain is aggravated after food intake and not relieved after passage of stools.
- h/o bloating 
- no h/o nausea, vomiting, diarrhea, chronic cough, fever, chest pain, headache, blurring of vision, burning micturition, reduced urine output and rashes over the skin.


Past History
- h/o renal calculi 3 years ago for which he underwent treatment
- h/o bilateral osteoarthritis for which he is on regular medication but stopped since 20 days ago
- n/k/c/o HTN, DM, TB, CVA, CAD, epilepsy, asthma and thyroid disorders 
- no h/o surgery 
- no h/o blood transfusions.


Personal History
- married
- manual labourer by occupation, stopped working since 10 days ago 
- mixed diet
- appetite normal 
- adequate sleep 
- regular bowel movements
- normal micturition  
- no known allergies
- occasional alcoholic 
- occasional gutka chewing, stopped since 5 years ago 


Family History
- Not significant


General Examination
- patient is conscious, coherent and cooperative 
- well oriented to time and space
- well built and adequately nourished
- no pallor
- no icterus
- no cyanosis 
- no clubbing of fingers
- no lymphadenopathy 
- bilateral pedal edema of pitting type present 
- temporal wasting present 
- no malnutrition 
- no dehydration 


Vitals
13/06/23
- BP: 120/70 mm Hg
- Pulse rate: 78 bpm
- Respiratory rate: 16 cpm
- Temperature: 97.4°F
- SPO2: 100% at RA
- GRBS: 137 mg/dL

14/06/23
- BP: 110/70 mm Hg
- Pulse rate: 70 bpm
- Respiratory rate: 16 cpm
- Temperature: afebrile 
- SPO2: % at RA
- GRBS: mg/dL

15/06/23
- BP: 110/80 mm Hg
- Pulse rate: 82 bpm
- Respiratory rate: 16 cpm
- Temperature: 98.2°F
- SPO2: % at RA
- GRBS: mg/dL


Systemic Examination
Cardiovascular System
- no thrills
- cardiac sounds S1 and S2 heard
- no cardiac murmurs

Respiratory System
- barrel shaped chest 
- no dyspnea
- no wheeze
- trachea position: central
- breath sounds: vesicular
- no adventitious sounds heard

Abdomen
- shape: obese
- no scars, striae, engorged veins
- tenderness present over epigastric swelling 
- bowel sounds heard
- no bruits, rubs
- no shifting of dullness
- no fluid thrill
- palpable mass of soft consistency in the epigastrium
- hernia orifices: normal 
- liver: not palpable 
- spleen : not palpable

Central Nervous System


Investigations

Treatment 

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