iloveGong

SHARIFAH’S NIGHT OUT

Demography: Female, married, 58 yo, housewife, 3 grown up children (2 d 1 s), slightly overweight (BMI=25)
CC: Epigastric pain
Over indulgence, nausea
HPI: When- on and off, worse last four days, frequent on few days ago, severe pain
Where-Middle
Quality- radiated to R side of the chest (tenderness), severe
Quantity-on off, 3-7
Better-No
Worse-Lie down, food
Associated symptoms-fever, feel like vomiting
Belief-heart attack
Fam Hx: father cholecystectomy, parents died due to old age,
Past Med Hx:
Diet: always kenduri
Social smoker- 3-4 cigarettes/day
Medication: No
Allergy: No
Travel: to Kelantan
O&G: 10 years post menopausal
Investigation: FBC, Urinalysis normal, liver function, cholesterol level (raised 5-10%), ultrasound, endoscopy, ECG normal, cardiac enzyme, 37.2oc, HR 80/min, BP 140/90, RR 12, ESR slightly raised, bilirubin borderline, alkaline phosphotase raised mildly, blood glucose normal, amylase normal
Murphy’s sign-a bit painful
Differential Diagnosis:
1. Cholecystitis
2. Hepatitis
3. Pancreatitis
4. Gastritis
5. Gastroesophageal reflux
6. Stomach cancer
7. MI

Learning issues
1) Overview of the anatomy of the GIT (Sam, Nic)
2) Pathophysio of chole, hep and GERD. Signs & symptoms. What are these 3 things? (Shamzi-GERD, Kieron- Chole, Luk-Hep)
3) Treatment and management (Syukriah- Chole, David- Hep, Deepak- GERD)
4) Investigations (Rosy- Chole, FC-GERD, Vir-Hep) *PCL is a bit different nowadays, we have to cover all 3 diseases, so just check out on which one you’re doing!