14-year-old male patient with chronic episodes of vomiting since two months

 14-year-old male patient with chronic episodes of vomiting since two months

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14-year-old male patient resident of Miryalaguda student by occupation came to the general medicine OPD with the chief complaint of chronic episodes of vomiting In 10 minutes  Of food intake.

History of presenting in Illness

Patient was apparently a symptomatic two months back, when he developed fever and a cough which lasted for two days followed by chronic vomiting since two months, vomitus is non-foul-smelling and content is food ,Along with water,Episodes of vomiting subsided 15 days back when the patient got back to his hostel then developed another episode of vomiting and hence was sent back home and is being having episodes of vomiting since then .

Patient Also says that he does not Vomit food After eating fried chips, biscuits, Bonda.

Patients attender Complains of weight loss Of two kgs in patient.(30 kgs to 28 kgs).

History of past illness 

History of fever associated with vomiting one year ago symptoms subside it on taking medication.

Patient is not a known case of Diabetes mellitus ,hypertension ,Asthma,Tuberculosis, epilepsy.

Personal history

Diet-Mixed

Appetite-normal

Sleep – adequate

Bowel and bladder – regular

Reduced urine output since two months

Addictions – none

General examination

Patient is conscious coherent cooperative, comfortable , Moderately built and moderately nourished

Afebrile

Pallor- ?

No icterus,Cyanosis,clubbing,pedal edema,lymphadenopathy.

Vital signs

Pulse – 82bpm

BP-100/70mmHg

respiratory rate – 

temperature-

Systemic examination

Shape-flat

Flanks-free

Umbilicus-inverted 

Skin-scratch marks

P/A-flat ,soft ,non-tender

Palpation

Superficial palpation – non-tender, warm

Deep palpation

Liver non-palpable ,Spleen non-palpable,

Percussion

No dull sounds heard 

Auscultation

Bowel sounds-heard 

CVS Examination-S1,S2 heard, No murmurs.

Examination of respiratory system-BAE positive, NVBS, no Added sounds

CNS examination-NAD

On psychiatric evaluation

On detail evaluation, no significant stressors found

Personal stresses positive, childhood (father an alcoholic), no precipitating event two months back.

Even after diversion, patient had an after having a sip of water.

 

Endoscopy imaging

Small hiatal hernia 

 Outside Ultrasound imaging

Reduced rbc and BB blood urea raised .

Treatment given 

Inj pantoprozol 40 mg /IV/OD

Inj zofer( ondansetron) 4mg/iv/tid

At 8 am -2pm-8pm

IVF 10NS at 75ml/hr

Diagnosis

Pyschogenic vomiting under evaluation