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This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. 

CASE PRESENTATION:

A 18yrs old female student,  unmarried came with c/o pain in abdomen associated with fever 1 week back.
Pt was apparently asymptomatic 2 yrs back.

In 2017 she started working in fields.

At age of 16th in the month of march 2018 she attained menarche,since then she had infrequent cycles 2/months lasted for 7 days.
High flow ,clots present.
Not associated with dysmenorrhea.
Changes 3pads/day.

In month of November in 2018, she got fever high grade associated with chills and rigors, then she admitted in hospital in miryalaguda, she was said to have low hb%, then 1PRBC  of blood transfusion is done and no other records are available. 

From then she developed back pain radiating to front lasting for nearly 5 days a week irrespective of her periods which aggravates with heavy work but she can do her daily routine work.

On & off chest pain from 1 month which aggravates with inspiration (?pleuritic).

Pain in abdomen since 15 days , diffuse type not associated with nausea, vomiting and loose motions associated with feeling of incomplete defecation,tenesmus present.
H/o streaky blood in stools on & off.

History of fever and icterus and took herbal medicine in 2016.

No h/o DM, HTN,Asthama, TB,CAD.
Appetite decreased since 7 days due to fever
Mixed diet 
Adequate sleep
Regular bowel and bladder movements ,constipation occasionally monthly twice.
No addictions 

General Examination:
Patient is c/c/c. Well oriented to t/p/p
Moderately built and well nourished 
Pallor - present 

No icterus, clubbing, cynosis ,lymphedenopathy ,edema 
Temp-98.6°F
PR: 96bpm
RR: 20cpm
BP: 100/70mmhg
SpO²- 99% @ room air

Systemic examination:- 

P/A: scaphoid, tenderness in para-umbilical region.A ball like mass felt at left hypochondrium region.

CVS: S1,S2 HEARD NO MURMURS

RS: BAE+,NO ADDED SOUNDS

CNS: NAD

INVESTIGATIONS:

Peripheral smear:


Ecg:
Day5

Chest x ray

2D ECHO:



                     Ultrasound abdomen :


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