A 57yr old male with constipation since 15days

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A 57yr old male came to OPD with

CHIEF COMPLAINTS of leg pains since 2months and constipation since 15days

HISTORY OF PRESENTING ILLNESS:

Patient was apparently alright 2months back then he developed leg pains which is insidious in onset and non progressive ,aggravates on sitting for long duration and relieves with walking.

He also has complaints of constipation since 15days associated with abdominal distension.

PAST HISTORY:

K/C/O DM since 4 yrs and on medication(glycomet GP2 forte)

N/K/C/O HTN,TB,Epilepsy,CVA,CAD

Daily routine:

He works as a government employee.He wakes up at 6am,goes for walk ,gets ready by 8am ,has his breakfast and leaves for work at around 10am,has his lunch at 2pm and comes back home by 4pm ,rest for sometime ,again goes for walk and has his dinner at around 8pm and goes to bed by 9pm.

His daily routine is not affected by the above complaints.

PERSONAL HISTORY:

Moderately built and nourished

Diet-mixed

Appetite-decreased

Bowel and bladder movements-constipation since 15days

Sleep-adequate

Addictions-

He is a chronic smoker since 20 yrs (daily 5-7 cigarettes)

FAMILY HISTORY:

Family history-His father was diabetic

GENERAL AND PHYSICAL EXAMINATION:-

Patient is conscious,coherent,cooperative

No pallor; Icterus; Clubbing; Cyanosis;

Lymphadenopathy absent

VITALS:

Temp:- Afebrile

PR:82bpm

BP:140/80mmHg

RR:21cpm

CVS EXAMINATION:

No visible pulsations, scars, engorged veins. No rise in jvp

Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.

S1 S2 heard . No murmurs.

Respiratory system :

Shape of chest is elliptical, b/l symmetrical.

Trachea is central. Expansion of chest is symmetrical

Bilateral Airway Entry - positive

Normal vesicular breath sounds

Per Abdominal examination:

Hard and non tender

Abdominal distension +

bowel sounds heard

CNS examination:

No focal neurological deficit

Normal speech

AUTONOMIC FUNCTION TESTS:

Heart rate variability during -

Orthostatic testing

Valsalva manoeuvre

during deep breathing

Cold pressor test

*ORTHOSTATIC TESTING:

In supine position - BP:140/80mmHg

PR:80bpm

In standing position (after 3min) - BP:140/90mmHg

PR:81bpm

-no significant postural drop

-no C/O dizziness,feeling of syncope or palpitations

*DURING DEEP BREATHING:

His BP - 150/80mmHg

PR-80bpm

*VALSALVA MANOEUVRE:

On voluntary forced expiration of patient against resistance - his BP was 140/90mmHg

-no symptoms of diarrhoea,urinary retention,urinary urgency

-no abnormal dryness of skin

TREATMENT:

1)Syp.Lactulose po/bd

[03/09/23, 9:21:33 AM] Rakesh Biswas Sir: Clinical images DP of abdominal and biceps lateral view

[03/09/23, 2:21:17 PM] Rakesh Biswas Sir: Bedside autonomic function tests? Did you review the literature around it? Please share what you learned

[03/09/23, 2:21:40 PM] Rakesh Biswas Sir: Share the link in 2018 group

[03/09/23, 2:21:47 PM] Rakesh Biswas Sir: The group link

[03/09/23, 6:03:49 PM] Tejaswini Kandhada: Autonomic function tests