35 YEAR OLD WITH HISTORY OF DIARRHOEA SINCE ONE MONTH
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15-09-2021
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35 year old female with diarrhoea since one month
CASE:
The patient came to the opd with chief complaint of passage of stools since one month.
HISTORY OF PRESENTING ILLNESS:
The patient was apparently asymptotic one month ago when she had an episode of diarrhoea since then she has 6-7 episodes every day which was small amount , non foul smelling and non blood tinged. She had no fever , abdominal pain, and cough. She has generalised weakness.
PAST HISTORY:
The patient noticed weight loss of since 6 months. She lost 5-6 kgs in the last six months.
She had no similar complaints in the past.
She was COVID 19 positive 5 months ago.
She does not have diabetes, hypertension, epilepsy, asthma
Her last lscs was 8 years ago.
No history of radiation exposure.
PERSONAL HISTORY:
Diet- vegetarian
Appetite-normal
Sleep-adequate
Bowel movements- diarrhoea since one month
Bladder: normal
Addictions- none
Allergies-none
FAMILY HISTORY:
no significant family history
GENERAL EXAMINATION :
The patient was conscious, coherent and co - operative.
He is well oriented to time, place and person.
Pallor was present
No icterus
No clubbing
No cyanosis
No generalized lymphadenopathy
VITALS:
pulse rate: 90bpm
blood pressure:130/80 mmhg
respiratory rate:20 cycles/min
SYSTEMIC EXAMINATION:
CVS: S1 and S2 are heard
No thrills and murmurs
RESPIRATORY SYSTEM:
Normal vesicular breath sounds are heard
BAE present
No dyspnea
ABDOMEN:
Shape of abdomen: scaphoid
No tenderness, no palpable mass, no free fluid, liver and spleen are not palpable
CENTRAL NERVOUS SYSTEM:
Speech: normal
No neck stiffness
Cranial nerves -N
Hand tremors are present
NECK EXAMINATION: there is a generalised midline swelling on the neck. It moves up on deglutition. It’s a diffuse swelling of the thyroid.
ECG:
INVESTIGATION:
Hb: day 1- 10.5 gm/dl
Day 2- 11.1 gm/dl
Day 3 - 10.8 gm/dl
HYPERTHYROIDISM
QUESTIONS:
1) what features indicate whether the patient has hyperthyroidism or grave’s disease?
2) what is causing this thyroid adenoma?
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