48 years old female K/c/o HTN On amlodipin Having indigestion since several days Nothing digest including liquid Patient had taken some treatment outside my hospital Reports attached below done outside I am thinking of IBD???? What’s your opinion

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Is there any significant weight loss?? Is it associated with vomitings?? Is it associated with any pain in the abdomen?? Is she on NSAIDS ?? Is she alcoholic or chews tobacco in any form ?? Is she has regular dietary habits?? What is her occupation?? Is she house wife or working lady?? Like soft ware people work in night shifts ,there will be disturbance in circadian rhythm and may result in indigestion. Is she suffered from fever before this indigestion?? What is her financial status?? Does she take food at home or outside like from hotels or restaurant s( fast foods or junk foods)?? Does she has goitre or any neck swelling or enlarged lymph nodes ?? All these details should be gathered in the history. Coming to the investigations CBP FPG and PPG HbA1C RFT LFT Serum electrolytes Serum amylase and lipase TFT Fasting lipid profile ECG 2D ECHO X ray chest to rule out Pulmonary koch's. USG abdomen and pelvis CT/ MRI Abdomen and pelvis MRI/ CT brain to rule out tumors. Upper GI scopy. Colonoscopy RTPCR to rule out Covid 19. Rule out gastric carcinoma or cancer any where in abdomen or pelvis. Rule out acid peptic disease like GERD, peptic ulcer, duodenal ulcer ,etc. Rule out gall stones lodged in the neck of gall bladder may cause distended gall bladder in USG abdomen in this case. Rule out Pulmonary koch's Rule out anxiety neurosis Rule out depression. Rule out gastroparesis Rule out irritable bowel syndrome. Rule out inflammatory bowel disease. Rule out H.pylori infection. Rule out any space occupying lesions in brain. Rule out any oesophageal candidiasis or cancer. Rule out Angina pectoris or CAD

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I think " indigestion" should be elaborated? Loose stools, ? Constipation , ? Bloating,? Stomach pain. If it is diarrhea, Stool exam including fecal Calprotectin, occult blood Barium meal series, Colonoscopy should be done .

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This patient is severely symptomatic ? Indigestion ? Acid peptic disease Adv Oesophago gastro duodenoscopy Colonoscopy This may help in confirming diagnosis

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Yes, Its anxiety neurosis.. You can give Clonezepam 1 tab sublingual. But not regularly. Dont discuss this pendemic casualities chapter before her.

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Pt seems to be a c/o anxiety neurosis Psychotherapy Tranquillisers Ppis Antacids Investigate from cardiac status Exg 2decho and cardiac enzymes Also do complete diabetic profile

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What are the findings of your clinical examination?? Bowel habits?Lft Rft? X ray scout abdomen. As Dr Jayesh said go for endoscopy, dd could be APD, subacute intestinal obstruction, Koch's abdomen . Please have consultation with a specialist.

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May be acid peptic disease/Anxiety neurosis Advise xray abdomen and endoscopy

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Respected DR.SUMIT , IT IS SIDE EFFECTS OF AMLODIPINE ( Calcium channel blockers ) please stop DEPINE . If needed take the opinion of knowledgeable Physician . Please please please don't rely on sonologists opinions.

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Functional dyspepsia Tab. Unienzyme 2 tablets chew just after having meal Chitrakadi gutika 2-0-2 before food Dadimashtak churna 2tsp with buttermilk

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Very good case, history should have been better, APPROACH is malabsorption table Harrison. My diagnosis possibly is antibiotic associated diarrhea. GIVE ENTEROGEMINA TWICE DAY, ZINCOVIT AT ÀBD, SEE REPONSE, IF RESPONDED ITS OK OR ELSE WORK UP ACCORDINGLY

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