An Interesting case of chronic diarrhoea

 New admission - casualty

73/ M presented with hypoglycemia and LOC . Corrected with 25 D .Bp- 130/90 ,pr-92 ,spo2-97 Ra.

Pt now C/c/c .


C/o Loose stools since 6 months intially 4-5 episodes per day . Liquid to semi solid consistency .Since 2 months frequency increased to 8-10 episodes of loose stools per day ,small quantity and yellow colour

No malena , bleeding PR , vomitings.

H/o intermittent pain abdomen and low grade fever present.

H/o 16 kgs weight loss since months .

Pt k/c/o Old CVA , CAD,HTN ,DM .

no addictions 

Past h/o henioplasty and hydrocele surgery


P/a - soft , distended

Bs+

Tenderness in left iliac fossa .

Diagnosis -Chronic diarrhoea under evaluation ( Large bowel diarrhoea)


Plan - all routine investigations and CECT abdomen , Endo,colon .


 Endoscopy and colon done in aug 2023 - normal


Cect abdomen done showing HCC 

Afp- 242.1

Tb-0.3 ,db-0.2 , ast /alt - 163,181

Alp-203 ,alb -3.5 

S creat -0.6

Serology negative

Hb-11.3 ,tlc - 4840 ,plt - 4lakhs






Micu

 Deepaksingh takur 

C/o pain in the epigastric region associated with shortness of breath

0/e : wheeze present 

? Hepatocelluar carcinoma secondary to paraneneplastic diarrhoea

Pateint conscious and coherent 

T-98.3 F

Bp -160/80 

Pr-98/min

Spo2 87 on 6 litres of oxygen 

Given nebulisation ,pantop and and advised chest xray and informed to ICU team and shifted to ICU sir

Trop I negative


Cag - Triple vessel disease


Micu

 Deepaksingh takhur


 Hepatocelluar carcinoma with paraneoplastic presentation as chronic diarrhoea.

? Nstemi/ acute pulmonary edema - resolved 

Cag - Triple vessel disease. Adv - ptca/medical management to RCA .

Known DM ,HTN ,OLD CVA .


Pateint conscious and coherent 

Bp -130/70 

Pr-72/min

Spo2 -93 on ra and 98on 2 litres of oxygen 

I/o - 2700/1950ml

Cvs -s1s2

Rs- clear 

Passed stools 3 times yesterday. No sob ,chest pain now 


pt is on diuretics , metrogyl,taxim , ecosprin ,heparin



Video of CT abdomen


Post op images : 




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