57 year old male vomiting for the past 3.5 months

May 19, 2022

NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT

Ht : 172cms

Wt: 55kgs

Bmi : 18.6

PAST HISTORY: The patient is a farm laborer and plantation worker by profession. Engaged in wheat, paddy, tobacco, and jute plantation. He is high-tempered which sometimes leads to minor family issues.

At the age of 13, had an incident of very high fever with vomiting and rashes for which he was admitted to the hospital. Had to stay in hospital for 7 days. At the age of 21, had an episode of diarrhea which lasted for 7 days, and had to be hospitalized. Started chewing (10 -12 times /day) paan, and areca nut at the age of 22 years. Continuing till date. Started alcohol at the age of 30, due to personal family problems. Used to drink 600 - 750 ml/day and on a few occasions even 1500 ml. Stopped at the age of 45 due to family pressure. Started smoking at the age of 30 due to peer pressure from work. To date continues to smoke 25bidis/day (pt is not smoking more than 5-10 bidis/day for the past 1 month).

PRESENT HISTORY: For the past 3.5 months he is vomiting within 24 hrs of eating anything. In case, he fails to vomit, due to nausea he would force himself to vomit by putting a finger inside his mouth. Unless and until he vomits, he cannot eat and feel very nauseous. Vomiting is non projectile, non-foul smelling, contains food contents, non-blood stained He will vomit 3 - 4 times at a gap of 1 - 1.5 hrs till his stomach feels empty. He can retail liquid diet longer. His attendant mentioned that he had lost weight (approx 25 kgs) drastically within a few months. Went to a Clinician, but the medication failed to work. Did Endoscopy and gastric ulceroproliferative growth ? with neoplastic changes detected. Complaint of loss of appetite. H/O constipation since 6 months one stool episode in 2-3 days. He is nondiabetic and his BP is normal.

FAMILY HISTORY: Everyone in the family chews paan and areca nut. Only he was an alcoholic and smoker. His wife and daughter suffer from vitiligo.

DIET: He loves to eat a very high protein diet since childhood. The attendant informed pt would have dried fish or some fries with puffed rice for breakfast. Regular chicken and fish for lunch and dinner.