35 years old female presented with long h/o upper abdominal pain and vomiting for last 6 months

1. Presented by :
Dr. Amit Kumar Shah
(Intern Doctor)
Department of Surgery
TMC & RCH

2. Particulars of the patient
 Name: : Mrs. Joriful Begum
 Age: 35 years
 Sex: female
 Relegion: islam
 Husband’s name: Md. Minhaz
 Occupation: housewife
 Date and time of admission: 13/10/22@ 7.27pm
 Date and time of examination:13/10/22@7.45pm

3. Chief complaints:
1. Pain in upper abdomen
for 5 years
2. Vomiting for 6 months

4. History of present illness :
According to the statement of
patient she was reasonably well 5
years back. Then she develops
recurrent attacks of pain in the
upper abdomen which is burning in
nature, not radiating, aggravated in
empty stomach and relieved by
eating.

5. Patient have similar attacks of pain
initially for 2 to 3 months and pain free
interval about 3 to 4 months. Then she
tooks some medication from local
pharmacist for releif of pain. But for
last 6 weeks patient is having constant
pain.

6. Pain associated with vomiting for last
6 months. She used to vomit 2 to 3
times daily, usually during evening,
sometimes after taking meal, which is
projectile in nature, copious in amout,
vomitus containing partially digested
food even contents of 2 to 3 days
before, yellowish, foul smelling,

7. frothy, sour in taste, causing
considerable relief and become hungry
again and there was H/O induced
vomiting. She has no history of loss of
appetite, lump in abdomen, pain
radiating to back or to shoulder. Her
bowel and bladder habit is normal.

8. History of past illness
She has no history of DM, HTN, heart
disease, asthma , Tuberculosis.

9. Personal history
Patient is non smoker, non alcoholic

10. Immunization history:
She is immunized as per EPI schedule.

11. Socioeconomic history:
She belongs to a middle class family,
lives in semi-pakka house and drinks
tube well water, uses sanitary latrine

12. Family history:
All other members of his family are
enjoying good health.

13. Menstrual history
Menstrual cycle : 28+/-2 days
Age of menarche: 13 years
LMP: amenorrhic for last 3 month
Menstrual flow : average
Age of last child: 17 years

14. Drug History:
she took some tablets from local
quack but couldn’t mentioned the
name .

15. GENERAL EXAMINATION
Appearance : ill looking
Body built: below average
Cooperation: cooperative
Decubitus :on choice
Nutritional status: below average
Anemia: absent
Jaundice: absent

16. Ill looking patient with NG tube in
situ

17. Cyanosis: absent
Clubbing: absent
Dehydration: moderately dehydrated
Edema: absent
Koilonychia: absent
Leuconychia: absent

18. Pulse : 76/min
Bp : 110/70mmhg
Temp : N
RR: 16/min
Lymph node: not enlagred
Hernia orifice : intact

19. Abdominal Examination:
Inspection:
 Shape: scaphoid
 Fullness in upper abdomen
 Visual peristalsis present from left to right
 Umbilicus : centrally placed and vertically slitted
 No scar mark, scratch mark engorged vein

20. Palpation
Temperature: not raised
Tenderness : Tender in epigastrium
No palpable mass , muscle gurd or
hyeresthesia
Liver , spleen , kidney not enlarged

21. Succusion splash : demonstrating

22. Percussion:
 Tympanic
 Fluid thrill and shifting dullness absent
Auscultation: bowel sound present

23.  Auscultopercussion: stomach is distended
 DRE: no abnormalities found
 Nervous system , respiratory system and CVS
examination revels no abnormalities.

24. Silent features:
Mrs. Joriful Begum, 35 years old
married, muslim, non smoker non
alcoholic, non diabetic , normotensive
housewife hailing from damodorpur ,
gobindogonj, gaibandha got admitted
to surgery orange unit TMC & RCH
with the complaints of recurrent
attacks of pain in

25. the upper abdomen which is burning
in nature, not radiating, aggravated in
empty stomach and relieved by eating.
Patient have similar attacks of pain
initially for 2 to 3 months and pain free
interval about 3 to 4 months. Then she
tooks some medication from local
pharmacist..

26. But for last 6 weeks patient is having
constant pain. Pain associated with
vomiting for last 6 months. She used to
vomit2 to 3 times daily, usually during
evening, sometimes after taking meal,
projectile in nature, copious in amout ,
vomitus containing partially digested
food even contents of 2 to 3 days
before,

27. yellowish, foul smelling, and frothy,
sour in taste, causing considerable
relief and become hungry again and
there was H/O induced vomiting. She
has no history of loss of appetite, lump
in abdomen, pain in radiating to back
or to shoulder. Her bowel and bladder
habit is normal.

28. On examination she is ill looking, co
operative , below average body built,
and poor nutritional status, pulse is
76/min, BP 110/70mmg , RR: 16/min,
temp : normal, dehydrated and no
edema. She is non anemic , non
icteric, no n cyanosed , lymph node
and thyroids and superficial veins are
not enlarged.

29. On abdominal examination abdomen
is scaphoid in shape , fullness of
epigastrium, umbilicus is centrally
placed, no scar marks , engorged vein
or scratch mark. On palpation
temperature normal, tenderness
present in epigastrium, no palpable
mass, no organomegaly,

30. succession splash is present. Tympanic
on percussion and bowel sound
present. Stomach is hugely distended
on auscultopercussion. Digital rectal
examination revels no abnormality.
Other examination revels no
abnormalities.

31. Provisonal diagnosis
Gastric outlet obstruction due to pyloric
stenosis

32. Differential diagnosis
Gastric outlet obstruction due to gastricarcinoma

33. Investigation
 For diagnosis: upper
GI endoscopy is done

34. Routine investigation:
CBC
RBS
S. Creatinine
CXR PA view
ECG
HbsAg
Blood grouping and Rh typing

37. Treatment:
Conservative treatment
 NPO
 NG suction
 IV fluid : NS
 Antibiotics: Ceftriaxone, metro

38. Preparing the patient for surgery
. NG suction and aspiration with
Normal saline

39. Surgical management
Gastrojejunostomy was done .

40. Thank you