45 yrs female with fatty liver

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.  

PATIENT HISTORY: Pt is a 45 yrs old female, a housewife but working as a teacher for an NGO.

When in primary school (aged 9-10 yrs) suffered from UTI (burning micturition, high fever).

When 10 yrs old, suffered from jaundice. 1-month bed rest.

Since childhood often suffered from cough, cold, and fever.

From age of 19-20 yrs, suffers from migraine attacks 2-3 times/month. Paracetamol with sleep provides relief.

When aged 30 yrs, she noticed a lump in her left breast. At that time no pain. Dr diagnosed it to be a benign tumor.

For the past 2-3 yrs, after eating immediately needs to go to the washroom. Passes normal stool 2-3 times daily. No complaints of digestion issues.

2 yrs ago, c/o intense pain in rt side of abd, when she tried to sleep on her rt side. USG revealed mild fatty liver. No treatment was done because of covid lockdown. 

She took AYurvedic medicines which reduced her pain somewhat. Now she can lie down on her rt side also. Pain felt mostly on palpation.

For the past 6-7 months, she c/o her legs swelling up and becoming painful on sitting for a long while teaching her students. Walking reduces edema and pain. She also c/o that her left breast appears larger than the right and the lump is now painful on palpation. It also pains more during her periods.

1 wk ago, she complained of lightheadedness, and shoulder pain. Her BP was 130-135/90. In Dr's chamber, her BP came to be around 126/82 mmHg.

Menstruation history: Since menarche, her periods occur 2-3 days before the expected date, lasting for 5 days. For the past 2-3 yrs, heavy bleeding on the second day (7-8 large pads needed, earlier only 2-3 pads needed). She also c/o dysmenorrhea.

Childbirth: At age of 26 yrs, via c-section. Normal delivery failed after 2 days of attempt. The Baby weighed 3.75 kg at the time of birth.

CHIEF COMPLAINT AND PT REQ: 

1) c/o pain in the upper quadrant of rt side of the abdomen.

2) legs swelling up and painful on sitting for long

3) has to go to the washroom immediately after eating for the past 2-3 yrs

4) heavy menstrual bleeding for the past 2-3 yrs.

5) c/o incomplete defecation (experiences slight pain while passing hard stool) sometimes

FAMILY HISTORY: 

Father - Parkinsonism, death at age of 78 yrs

Mother - 78 yrs old. Diagnosed with hypothyroidism and HTN, cholelithiasis (operated). For the past few months smelly urine and pedal edema

Sister - DM

REPORTS:

MEDICATION:

Pt only taking Ca2+ tab since she feels she is not that ill.