A 36 year old woman with pain abdomen and blood in vomitus

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A 36 year old woman, farmer by occupation, resident of Tirumalagiri came to medicine OPD with 

chief complaints of

Pain abdomen since 1 month

Blood in vomiting 1 episode 1 day ago

History of Present illness-

The patient was apparently asymptomatic 1 month ago and then she developed, pain in the epigastric region, which is of squeezing type, aggravated on consumption of spicy, sour and non-vegetarian foods, sometimes relieved after an episode of vomiting. It is non radiating and no migration of pain. There’s is no positional variation.

She had had over 10 episodes of vomiting, in the last 1 month which is non projectile, non bilious and food as it’s content. Sometimes, early morning retching, induced vomiting. A day ago, she had an episode of vomiting with some blood which is dark brown in colour.

No h/o fever, blotting, constipation, loose stools, cough, shortness of breath, chest pain. No retrosternal burning.

Menstrual history-

Menarche at the age of 13 years

Marriage at the age of 12 years

30 days/ 5

8 pads per cycle

No h/o clots, white discharge, burning micturition

Obstetric History- 3 children 

1st boy,by LSCS , now 20 years old

2nd female, by LSCS, now 16 years old

3rd boy, by LSCS, now 14 years old

Tubectomy done immediately after last delivery 

Past History-

11 years ago, she was diagnosed with Renal Calculi, which was resolved on medication 

2 months ago she was diagnosed with renal caliculi again, which was reported resolved in the ultrasound scan a day ago

N/k/c/o HTN, DM, TB, Asthma, CAD, Thyroid, Epilepsy

Family History- no significant family history

Personal History-

 • Married

 • Diet mixed

 • Appetite normal

 • Sleep adequate 

 • Bowel and bladder movements regular 

 • Addictions- 250 ml toddy occasionally 

 • Food allergy to gongura, fish and brinjal which was found out 1 year ago after having mild rashes anywhere any body especially hands

General examination 

Physical examination -

 • The patient is conscious, cooperative and coherent

 • Well oriented with time, place and person

 • No pallor

 • No icterus

 • No cyanosis

 • No clubbing of fingers

 • No lymphadenopathy 

 • No pedal oedema