CHRONIC VOMITINGS UNDER EVALUATION

C/0 vomitings since 2 months 
Pain abdomen since 2 months
Generalized body pains

HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 2 YEARS BACK, SHE HAD INJURY TO RIGHT LEG WHICH TURNED TO ULCER AND HELAED WITHIN ONE MONTH.
SINCE 6 ME NTHS PATIENT HAD BLUSTERS AT THE SAME SITE OF INJURY FOLLOWED BY ULCERATION.DAILY  DRESSINGS WAS DONE AT LOCAL HOSPITAL.
SINCE 2 MONTHS PATIENT HAS VOMITINGS, ON AND OFF ON AN AVERAGE OF 2 EPISODES OF VOMITINGS, NON PROJECTILE,NON BILIOUS WITH FOOD PARTICLES AS CONTENTS.
NO H/O FEVER, NO LOOSE STOOLS,
NOT A K/K/O HTN,DM,TB,BA

VITALS: AFEBRILE.   PR-90.   RR-18.   BP-110/70.    SPO2 98%

GASTRO-ENTEROLOGY I/V/O CHRONIC VOMITINGS: DIFFUSE GASTRITIS SMALL HIATUS HERNIA.

SURGERY REFERAL I/V/O AN ULCER-AN ULCER OF SIZE 10X7 CMS OVER R LEG-MEDIAL ASPECT,GREENISH DISCHARGE ORESENT,PALE GRANULATION TISSUE PRESENT.
Rx : DAILY DRESSINGS WITH OINTMENT MEGAHEAL.
TAB.PAN 40 MG OD
TAB.ONDEN 4MG BD   1-----X-----1
SYP.ARYSTOZYME 10ML/TID
TAB.ZINCOVIT OD.   X-----1-----X

PSYCHIATRY REFERAL -ADJUSTMENT ISSUES DUE TO PHYSICAL ILLNESS.

INVESTIGATIONS: HAEMOGRAM,LFT,RFT,CXR,ECG,USG ABDOMEN

DIAGNOSIS: CHRONIC VOMITINGS UNDER EVALUATION SECONDARY TO GASTRIC OUTLET OBSTRUCTION.

TREATMENT: 
1) IVF NS,RL,DNS. @75ML/HR
2)INJ.ZOFER 4MG/IV/TID
3)INJ.MONOCEF 1 GM/IV/BD
4)INJ.OPTINEURON 1 AMP IN 100 ML NS/IV/OD
5)TAB.PCM 650 MG /PO/SOS
6) DAILY DRESSINGS WITH MEGAHEAL OINTMENT
7)BP/PR/TEMP MONITORING AND GRBS CHARTING(12TH HOURLY)


(1)DAILY DRESSINGS WITH OINTMENT MEGAHEAL.
(2)TAB.PAN 40 MG OD FOR 5 DAYS
(3)TAB.ONDEN 4MG PO/BD FOR 5 DAYS
(4)SYP.ARYSTOZYME 10ML/TID FOR 5 DAYS
(5)TAB.ZINCOVIT po/ OD. FOR  14 DAYS
(6) TAB.PCM 500 MG SOS 

REVIEW TO SURGERY OPD SOS.  I/V/O ULCER 



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