Gow | Khwaja Yuaus Ali Medical College ‘Signature oflavigiator seinen Covcnena of Shoah Povtiudar’s of the patient s— Nome; Ages $ext Region! Marital status: Oerspalion t Aaverst Dale of adminione Date of exarnination ¢ chief Compl () fain in the upper abdomen fos {77 month ©) Vomiting eflex meal for [—] month (B) Lump in the Upper abdomen fer [—] month ProHoley af present ithnewst- Acerding fo fue. Sketement of phe. patients he/she was reaorably well [] months beck. Then he developed pain in the upper abdomen Which is continuous dull aehirg in nature , aggravated boy faking meal, not -veliened by antacids but yelieved by after vomiting» moby radioding, snot anotiated & fover , chills and Uppey alodesnen Area > Epiyastrivam 7 Pointing sn; Muxpy’s Sign’, Rebound tendernem, Rovsing sip abeent PTOsite > epgandie region Size > about x0 em Shape > Ierequlan Sucface > Trrequlow Margin > iI dehined, No upper margin berntsloney —9 Hard Fivity > Not cfited & averlying. BP vat ey ry Shechne, Non- pulsatile Moves & respiration 7 Organ palpabion:— Liver, Spleon , kidmey ; Vrinany " bladder not pal pable_ 7 Suceuien splash > Avsend (2) fewunion:- Nole > Forpanie. Fluid Holl! Absent Shifting dulinens: Absent (©) Aureattation'— Bowel sound > Present Added Sound —>. fbsert Peyo(E) Porvaginal examimafion: Not dene LE) Pevsvectal ekaminahion— Merartatie, deposit } Blumer shelf 13 found Ftamination of “other system No abnersmality detected Salient foakeve =" My. X, Ly eas old | menvied/ tumrervied » Smorker(/ non-smoker ,aleawVe/ non-aleb- bolic, DrabeHe/nem dabet7e , Hypertensive / Normatorsi hailing from TJ got admitted mm tis hoipital & the complain of ‘pain 7m the Lepper a bdermen for L] oonth whieh 5 esntinwowr dlutl aching in nature, aggravated by feabing meal mo} yelieved by antecid buf-relieved offer vemitiog, nem—vadialivy’, net axceiated & foyer, chills and Tee + B'S0 earrp laine of vomiting fir loot 1 menths . Oeteving alrmest daily for lot C] ment but Last C1 month vomiting be har beeome len as he taking ten food, Vomiting oeeuring about J hour affer meal Dhieh 1S profecitle , non- bilvour and eantaining PTOboth diyepteA amd undrerted frod materials whieh relieve ie oe fr aloo torrplained of a yelling ran I Yue Upper abdomen , Whieh enle ropidly not painful . He abe complained af toss of appetite and eqnificant weight 10. Rene His bowel ‘amd bladder habit & normal There i no'hshery of pun, tm vornitxy out of bleed or parazec$ Luck teory stool, yellow deo leration of eye Skin, eheot fat ,bone pain, Couph Om examination, hehe i -amxiow>, i]! Hoking, Cocopenadive ; below average toody built and poor nubitional SJaluo, Anemte, helydvated , Yyanaris edema , Jaundice lulbing , koiloychia , lewkony ehia ; aocites ave absent. All vital sion arre normal « On lage-veginal erarmination of abdrmem:— Abdemen is normal inshape. & fullnern of eFepeotre ‘regan _ Ombilieous centrally placed inverted, no seammark, mo engorged vein PaOOn palpalion tom % nevmal , tendemers prerent Th the epitpobie. region ne orgamenegally There. % palpable imnabderina luerp In the epigarkie weqion Dkieh 1 tender , meauring about xD em irregular sucface , ill defined raargin, Waad In Unoisteney , non pulsakile rmoven & veopiraton, not fitied 2 the overlying Skin or underly my shueture Tynpente on pereurrion and bowel sound present, DRE vevedls blummer shelf (®) Caveinema of Head of the panereas @) Peniorm peallarey loreinoma pOeRe EESR 1) Serlum eleabolyte , ereadinine \ 7 RBS 2 rine RNIB (Beh OD Specific: 7 Upper GIT endoeopy amd biopsy 1 Bonjuam -manti-vay of Smash and 1 US of Bkole alodemen Ti Ee » CE seonof Whole abdymen 1 Boe gean , 1 Chant x-ray P/A view Thesdment: General, Speetlie: , Spmplematie and RK of tomptitations Fellow up :—