Short case 2

 A 33 year salesman, who was apparently asymptomatic 4 months ago, came to the OPD with C/O weight loss. 


Pt was apparently asymptomatic 4 months ago, then noticed a weight loss of 16 kgs i.e from 86kgs to 72 kgs in the 4 month duration. He then went to a local doctor and was later diagnosed with Diabetes Mellitus. He was treated with Glimepride 2mg + Pioglitazone 15mg and metformin 1000mg. His blood glucose levels were under control since the start of the treatment. 

The patient eventually developed loose stools-1-2 episodes/day with loose consistency,normal volume and colour,not associated with mucus or blood in stools. No change in volume of stool.

Consumption of milk and milk products like paneer aggravated his diarrhea to 3-4 times/ day.

C/O tenesmus, incomplete evacuation, mucus in the stool. 

C/O frothy stool once in a month.

C/O abdominal pain since 3 months with pain radiating to the back. Ranitidine 150 mg on and off when the patient has gaseous distension.

C/O chest pain on and off for 3 months assosiated with gaseous distension. No radiation to arm, No SOB on exertion, no palpitations. 

Non-foul smelling- due to the patients anosmia.

No H/O Malena.

No H/O hematochezia, no Hemorrhoids.

No H/O burning micturition.

Normal appetite

No H/O fever, vomiting, jaundice, joint pains, surgeries or TB.

No H/O rash 

Past H/O:

No similar complaints in the past.

No H/O of HTN, CVA, CAD 

No herbal medications, no previous transfusions.

Personal History : 

Alcohol- 3 times/ month 180 ml and smoked cigarettes for the past 12 years. No Tobacco chewing.

Vitals:

BP: 110/79

PR: 80 bpm

Spo2- 99% @ room air

RR- 15/min.


Provisional Diagnosis : Chronic Diarrhea.






























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