CHENGALPATTU MEDICAL
COLLEGE
DEPARTMENT OF GENERAL
SURGERY
SURGIFEST UG 2018
HEMA D
FINAL YEAR MBBS
Mr.Thirunavukarasu a 55yr old male, a farmer
by occupation hailing from Aathur village came
with chief complaints of
1.Upper abdominal pain for the past 1month
2.Vomiting for the past 1 month
H/o presenting illness:
The patient was apparently normal 1 Month back
when he developed
Abdominal pain:
Epigastric region
For 1 month
Dull aching pain
No relation to food intake
Non radiating
No aggravating and relieving factors
No diurnal and seasonal variations
Vomiting:
For 1 month
After half an hour to 1 hour of food intake
Spontaneous, not induced
Contained undigested food particles
Not foul smelling
Non bilious not blood stained
Non projectile
H/o loss of appetite present
H/o loss of weight present
H/o early satiety present
H/o bloating and ball rolling movements present
No H/o heartburn
No H/o hematemesis or melena
No H/o constipation
No H/o yellowish discolouration of eyes
No H/o cough with hemoptysis
No H/o Bone pain
Past History:
No H/o similar complaints in the past
Not a case of DM/HT/CAD/TB/Bronchial Asthma
No H/o Previous surgery
No H/o antacid intake/No history suggestive of acid
peptic disease in the past
No H/o chronic consumption of NSAIDs in the past
Personal History:
Takes mixed diet
No H/o consumption of spicy foods
Not a smoker or an alcoholic
Family History:
Not contributory
No cancer deaths in the family
General Examination:
Conscious and well oriented
Moderately built and nourished
Pallor present
Hyadration status is fair
No icterus/cyanosis/clubbing/pedal edema/generalised
lymphadenopathy
Left supraclavicular node- not palpable
Vitals:
Pulse Rate- 70 beats /min
Blood pressure- 120/70 mmHg
Respiratory Rate- 16 breaths/min
Temperature- 98.4 degree F
Local Examination of
Abdomen:
After obtaining informed verbal
consent, the patient is examined
in supine posture with hips and
knees flexed.
Adequate exposure by stripping
from xiphisternum to pubic
symphysis
Inspection: (in supine posture)
Abdomen is normal in contour
All quadrants move equally with respiration
Umbilicus is in midline and inverted
A mass is seen in the epigastric region of
approximate size 7*5 cms which moves with
respiration
Skin over the swelling appears normal
A wave like peristaltic movement was seen from left
to right hypochondrium crossing the
epigastrium(Visible Gastric Peristalsis)
No pulsations/dilated veins/scars/sinuses
No nodules around the umbilicus
Flanks free
Hernial orifices were free
External genitalia was normal
No supraclavicular fossa fullness
Palpation:
Not warm
Not tender
Non pulsatile mass palpable in the epigastric
region of size 7* 4 cm ovoid in shape
Ill defined margins
Irregular surface, firm in consistency.
The swelling moves down during inspiration
Contd...
Plane of the swelling- Intraabdominal
No oraganomegaly
No lymph nodes palpable
Percussion:
Liver dullness felt in the Right fifth ICS at the
midclavicular line
Percussion over the mass was dull
Liver dullness was not continuous with the mass
Auscultation:
Succusion splash- Splashing sound heard(the
patient did not eat/drink anything before 4 hours).
Auscultopercussion- when the points are
connected, the greater curvature of stomach lies at
the level of the umbilicus.
Normal bowel sounds heard
Per Rectal examination- to be done
Other systems:
RS-Normal vesicular Breath sounds heard
No added sounds
CVS-S1,S2 heard
No murmurs
CNS-No focal neurological deficit
DIAGNOSIS:
A case of Gastric Outlet Obstruction
probably due to carcinoma stomach
with no clinical evidence of metastasis
THANKYOU
