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 A 75 year old daily wage worker resident of narapuram came to general medicine OPD with chief complaints of swelling with pain above umbilicus  since 5 years.

History of present illness

Patient was apparently asymptomatic 5 years ago then he noticed  a swelling which is sudden in onset gradually progressive and painless initially which later became tender and painfull.

No aggravating or relieving factors for pain . The size of the swelling gradually increased . The current size of the swelling is about 3×4 cm.

No history of fever ,vomitings.

No history of cough .

No history of decreased urine out put and burning micturation.

Past history

Not a known case of diabetes , hypertension , epilepsy, asthma, tuberculosis 

History of Extracorporeal shockwave lithotripsy for left renal calculi 3 years ago.

Personal history 

Diet -mixed 

Appetite -normal 

Bowel and bladder movements -regular 

Sleep -adequate 

Addictions -occasionally  alcohol 

 Daily route 

Patient gets up daily at 4 am then he does he's eats roti and jawa for break fast goes to work by cycle and return home between 12 to 1pm he usually have his lunch between 12 30 to 1 pm which is mostly rice .Then in the evening he somes goes to his farm

His dinner is rice  and curry most of the time

He goes to sleep 10 pm.

Family history 

Not significant

General examination

Patient was conscious, coherent, cooperative and well oriented to time ,place and personPatient was moderately built and well nourished




No pallor, icterus, cyanosis, clubbing, edema and lymphadenopathy












Vitals:


Temp - afebrile

RR - 16/min

Bp - 120 /70 mm of Hg

PR - 78 /min


Systemic examination:

CVS - S1 and S2 heard , no murmurs

CNS - Normal

RAS -

 BAE +


Provisional diagnosis - epigastric hernia

Investigations






Diagnosis  epigastric hernia with thrombocytopenia.

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