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This is a case of 46 year old female diagnosed with functional bowel disease with history of H/O  tobacco use & Attention Seeking

(History taken from pt with help of translator [pt son]

Admitted in summer 2021   (day 1 ) 

Day 2

CHIEF COMPLAINTS:

  • Pain abdomen since 2-3 months
  • Abdominal distension since 1 month


HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic/normal 12 yrs back then she had history of fall due to slip while she was carrying a load of water to her home following which she developed low back ache radiating to legs subsided after taking medications.

Since 2-3 months she had pain abdomen which is gradual onset, not associated with nausea/vomiting, no h/o weight loss, no loss of appetite, no easy fatiguability.

Since 1 month she observed abdominal distension, which is insidious onset ,gradual and not associated with constipation, no obstipation, no decreased urine output.







N/k/c/o HTN,DM,BA,TB.


TREATMENT HISTORY:

Not significant


PERSONAL HISTORY:

 • Married

 • Homemaker/farmer

 • Normal appetite

 • Mixed diet

 • Regular Bowel movements

 • No known allergies

 • Tobacco consumption


FAMILY HISTORY:

Not significant


PHYSICAL EXAMINATION:

Pallor: -

Icterus: -

Cyanosis: -

Clubbing: -

Koilonychyia: -

Lymphadenopathy: -

Edema: -


VITALS:

BP: 140/90 mmHg

PR: 76 bpm

RR:  18cpm

Temperature: Afebrile

GRBS: 136mg/dl

SpO2: 99% on RA


SYSTEMIC EXAMINATION

CVS:

S1, S2 heard

No thrills

No murmurs


Resp S:

Trachea centrally located

No dyspnea

No wheeze

Vesicular breath sounds

No Adventitious breath sounds


ABDOMEN:

Shape: Obese

No tenderness

No palpy mass

No bruits

No free fluid


CNS:

Conscious

Coherent

Cooperative

Normal speech

No signs of meningeal irritation


CEREBRAL SIGNS:

None


PROVISIONAL DIAGNOSIS:

Acute gastritis with psychiatry opinion


PLAN OF TREATMENT:

Day 3

 • Tab. PAN 40 mg PO/OD

 • Tab. MVT PO/OD

 • BP/PR/Temp/SpO2 Monitoring 4th hourly

 • GRBS 12th hourly monitoring


Day 4

 • Tab. PAN 40 mg PO/OD

 • Tab. MVT PO/OD

 • BP/PR/Temp/SpO2 Monitoring 4th hourly

 • GRBS 12th hourly monitoring


Day 5

 • Tab. PAN 40 mg PO/OD

 • Tab. MVT PO/OD

 • BP/PR/Temp/SpO2 Monitoring 4th hourly

 • GRBS 12th hourly monitoring


Day 6

 • Tab. PAN 40 mg PO/OD

 • Tab. MVT PO/OD

 • BP/PR/Temp/SpO2 Monitoring 4th hourly

 • GRBS 12th hourly monitoring


Day 7

 • Tab. PAN 40 mg PO/OD

 • Tab. MVT PO/OD

 • BP/PR/Temp/SpO2 Monitoring 4th hourly

 • GRBS 12th hourly monitoring


INVESTIGATIONS:

 • CBP

 • CUE

 • Blood Urea

 • Serum Creatinine

 • ECG

 • Endoscopy : mild fundal gastritis

 • Psychiatry opinion

 

ECG



CBP





URINE EXAMINATION





SERUM ELECTROLYTES





TPR


UGIE REPORT



 

ULTRASOUND





Psychiatric Evaluation :


Day 2               2:30pm 

C/S/B Dept. of Psychiatry 

             This is a case of 46 year old female diagnosed with functional bowel disease with history of H/O   tobacco use & Attention Seeking

(History taken from pt with help of translator [pt son]

 C/C - 

  • Pain abdomen  ∵  2 years
  • Abdominal Distention  ∵  3 months
Patient was apparently asymptomatic 2 years back when she experienced sudden pain abdomen in epigastric. Rt hypochondriac region for which consulted doctor and use medication for 2 to 3 days.
Pt. Says that this did not subside completely after using medication and she did not bother about as could do her daily activities.

3 months back pt. observed pain abdomen of burning type in epigastric region, during which she also observed abdominal distension for which she again consulted doctor. As doctor could not explain them the cause of pain they came to OPD for further treatment.

Pt. Says that her pain subsides on doing work and aggravates during sleep.

Pt. used tobacco since 15 years stopped consuming since 1 month
Pt. Denies any withdrawal symptoms

Pt. denies any H/O
  • personal
  • occupational
  • familial
  • sexual
  • Financial stressors

- No H/O head injury seizures
- No H/O pervasive low mood suicidal ideas
- No H/O Bizarre belief, self talking, suspiciousness
- No H/O flight of ideas , grandiosity
- No H/O other substance use
- No H/O suspending doom or any other anxiety symptoms.

OD denies any features of
-Self mutilation
-over concern with physical attractiveness
-manipulative behaviour

N/K/C/o HTN, DM, BA , TB

No significant past & family history of psychiatric illness

MSEI - pt looking appropriate to age moderately built dressed appropriately

ETEC +ve sustained
PMA : - ve
Rapport Established (with help of translator)

Speech T -ve. RT -ve
V -ve
R -ve

Relevant & Coherent
Attitude - cooperative
Mood/Affect- dysphoric
Thought- Preoccupations of health
Perception-NAD

Oriented to T+/P+/P+

HAM-D : 7
HAM-A : 1

Insp: 1) Functional Bowel Syndrome
2) Tobacco Harmful use.

USG Abd :- S

PLAN-
1) Review to PSY OP on Monday for psychotherapy.




Day 4     10:00 am 

C/S/B Dept of Psychiatry 


 -Pt. says that her pain abdomen subsided on taking medicines 


Significant MSE:- 

Pt. sitting in chair responding appropriately to question asked by translator (son) 
ETC + ve sustained 
PMA  -ve
Rapport - Established
Speech - T       -ve                             RT -ve
               V      -ve      
               R       -ve

relevant & coherent 
mood / affect - Euthymic
Thought - preoccupations about health
Perception- NAD 

imp- Briquet's Syndrome ( Somatization Disorder) 

To rule out :- 
? F06.4 Organic Anxiety Disorder
? F32.01  Mild Depressive with Somatic Syndrome
? F22.0  Delusional Disorder
? F45.2 Hypochondriacal Disorder
? F60.4 Histrionic Personality Disorder

Adv. 
Rorchach's
TAT
IPDE
MDRAS
GFA    (review with report & SOS)
   

Rx 
1. T. FLUOXETINE 20mg  1--x--x
2. T. OPIPROL 50mg    1---x---1

DISCHARGE DATE  :  Day 9
Ward : GM 
Unit : 1 

Advice at Discharge : 
Take medication as advice 
Practice Yoga, Meditation & Other Stress Relieving Exercises

Follow Up 
SOS review

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