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