A 50 year old male with epigastric pain

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This is a case of a 50 year old male with complaints of fever since 5 days and epigastric pain since 4 days

History of Presenting Illness

Patient was apparently asymptomatic 5 days ago. Then he developed fever. It lasted for a day and was associated with chills and rigours and subsided with antipyretics. Then later in the evening he developed epigastric pain after the fever subsided. Pain is in the epigastric and right hypochondriac region primarily, gradually progressive in onset, it is of a dragging type of pain, he says its radiating to his flanks and lower back. He has decreased appetite since 4 days and has not been passing stools. The pain is exacerbating when he has food.

He also says he had shortness of breath of grade 2, two days back, but it has relieved now. No history of orthopnea or PND

DAILY ROUTINE:

The patient wakes up at around 4 am and completes his daily morning activities. He is a labourer by occupation so he goes to work at 5 am and comes back home at 8 am to have food. Depending on the type of work he does that particular day, the time he comes home sometimes varies. At around 9:30 he goes back to work and doesn’t come back home at around 6 pm. He has food and sleeps by 9 pm. He consumes alcohol everyday regularly at 6 pm of 90 ml since the past 10-15 years. He also smokes one beedi a day since the past 30 years.

Events leading to the present day:

The patient as usual woke up and went to work. He said his work that day was spraying fruits with some chemicals. He came home around at 11 am that day to have food. He had rice and dahl and developed fever insidiously after eating. His fever subsided in the evening and then he developed epigastric pain. He has not been going to work since the past few days and is at home taking rest since the pain is so severe. No one else in the family had similar complaints.

Past history:

He has no similar complaints in the past. Not a k/c/o diabetes, hypertension

No history of blood transfusion.

General examination

Pallor: present

Icterus:present

Clubbing: absent

Cyanosis: absent

Lymphadenopathy: absent

Edema: absent

Vitals:

Temp: afebrile on time of examination