34 year old female, resident of West Bengal, homemaker by occupation has come with c/o :
Abdominal pain since 1 and a half year
Chest pain since 6 months
History of presenting illness :
In 2017, patient developed bilateral loin pain which was of stabbing type, non radiating, continuous, increases on movement.
Pain on standing up from sitting position +
In 2020, she was taken to a hospital where she was diagnosed with unicornuate uterus and bilateral polycystic ovaries.
She underwent laparoscopic ovarian drill.
In 2021, the patient had delivered her first child by Caesarean section (as the baby was in breech position)
Ever since, she complains of abdominal pain (epigastric region) which is insidious, pricking type, intermittent, non radiating and associated with bloating.
No h/o belching, regurgitation
No h/o constipation, nausea, vomiting
Patient complains of chest pain since 6 months which is insidious, pricking type, non radiating, not altered with food intake.
Pain is more at night, increases on lying down and associated with reduced sleep time. (1-2 hours per night)
No h/o SOB, Palpitations
No h/o cough
Series of events :
•Patient got married in 2015 at the age of 24 years.
•In 2016, She had irregular menstrual cycles. She used to get her period in every 3-4 months. It used to last for 4-5 days. The flow was reduced. She used to use 1-2 pads per day.
She went to see a local doctor regarding the above problem.
The doctor said she might be having a renal stone because of which her cycles are irregular.
•In 2017, she developed bilateral loin pain which is of stabbing type, continuous, non radiating, increases on movement
Pain on standing from sitting position +
•She went to Apollo, Chennai. They performed ultrasound and she was found to have :
Unicornuate uterus
Severe bilateral polycystic ovaries
Primary infertility
Ultrasound report :
•They performed laparoscopic bilateral ovarian drilling.
•In 2021, she gave birth to her first child at the age of 30.
•Ever since, she’s been complaining of abdominal pain associated with bloating.
•Since 6 months, she’s been complaining of chest pain associated with reduced sleep time.
Daily routine :
Patient is a homemaker.
She wakes up by 7 am in the morning
Has a cup of tea and biscuits for breakfast
She does her home chores and looks after her child
She has lunch at 1 pm. She has a bowl of rice and curry
She has another cup of tea in the evening
She has dinner by 8 pm in the night and goes to bed by 11 pm
She sleeps for 7-8 hours
She occasionally eats spicy food.
Since 6 months, her sleep time has been reduced due to chest pain. She sleeps for 1-2 hours per night.
Past History :
N/k/c/o HTN, DM, Thyroid disorders, CAD, Asthma and Epilepsy
H/O laproscopic ovarian drilling done in 2020 for B/L polycystic ovaries and unicornuate uterus.
Family history :
No similar complaints in the family
Menstrual history :
LMP - 7th July 2023
Age of menarche - 14 years
Duration of cycle - 30 days
No : of days bleeding - 4 to 5 days
No : of pads used per day - 3 to 4 pads per day
Obstetric history:
Age at marriage - 24 years
Age at birth of first child - 30 years
Weight before pregnancy - 52 kgs
Weight during pregnancy - 64 kgs
Pregnancy was eventful
Baby was delivered by Caesarean section (breech position)
No abortions
Personal history :
Sleep : reduced
Diet : mixed
Appetite : normal
Bowel and bladder : regular
Addictions : none
General examination:
Pt is conscious, coherent and cooperative
No pallor , icterus , cyanosis, clubbing, lympadenopathy, edema
Vitals :
PR: 78 bpm
RR: 14 cpm
BP: 120/70 mmHg
GRBS : 103 mg/dl
Systemic examination :
CVS : S1 S2 heard no murmurs
RS : BAE NVBS heard.
P/A : soft non tender
No free fluid.
Caesarean section scar present
Wrinkles +
Umbilicus everted
CNS : No FND
RIGHT. LEFT
UL. 5/5 5/5
POWER LL. 5/5 5/5
TONE. UL. Normal. Normal
LL. Normal. Normal
REFLEXES RIGHT. LEFT
B. ++ ++
T. ++ ++
S + +
K ++ ++
A ++ ++
P. Flexors. Flexors
Investigations :
•2020 :
X- Ray :
General Surgery Referral on 26/07/23:
On examination:
A defect of size 4×1 CM above and below the umbilicus present
Cough impulse +
Diagnosis :
UMBILICAL HERNIA with NON CYCLICAL MASTALGIA
Advice:
1. Tab EVION 400MG PO/BD × 5 DAYS
2. TAB. ZERODOL P PO/SOS
3. TAB. PRIMEROSE OIL 1GM PO/OD × 7 DAYS
4. Patient was advised for mesh hernioplasty but the patient is not willing to get it done.
GYNAECOLOGY REFERRAL ON 26/07/23
O/E
P/A:
SOFT, NON TENDER,
NO TENDERNESS ON DEEP PALPATION.
SUPRA PUBIC TRANSVERSE SCAR PRESENT.
L/E:
SWELLING OVER UMBILICAL REGION NOT ASSOCIATED WITH PAIN.
COUGH IMPULSE PRESENT.
PATIENT NOT WILLING FOR PER SPECULUM EXAMINATION.
DIAGNOSIS :
35 YEAR OLD P1L1 WITH 1 PREVIOUS LSCS WITH UMBILICAL HERNIA WITH ? UTI
ADVICE :
CUE
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