65 yr old female with chief complaints of diarrhoea, vomitings , and generalised weakness since 5 days

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65 yr old female with chief complaints of diarrhoea, vomitings , and generalised weakness since 5 days

History of present illness:

Patient was apparently asymptomatic 5 days back later she developed diarrhoea for 2 days 5-6 episodes per day loose stools . No h/o blood in stools associated with vomitings since 1 day non bilious , non projectile , non foul smelling food as content 2-3 episodes.

H/o generalised weakness since 4 days

No h/o pain abdomen ,no h/o fever 

No h/o decreased urine output

Past history:

N/k/c/o DM,asthma,HTN,epilepsy,cad,cva ,TB

General examination:

Patient is c/c/c 

No signs of pallor,icterus,clubbing,cyanosis,lymphadenopathy 

Temp 97.8 F

BP 140/90 mm hg

PR 102 bpm

RR 16 cpm

Spo2 98 on RA

Systemic examination:

CVS : S1S2 heard

RS :BAE +

CNS :NFND

GIT: soft ,NT

Surgery referral:

Investigations:

Diagnosis:

?Subacute small bowel obstruction 

? Thrombocytopenia under evaluation 

Treatment:

1. NBM till further orders

2. IVF NS @50ml/hr

3. INJ. CEFTRIAXONE 1GM /IV/BD

4. INJ. PAN 40 MG /IV/OD

5.ABDOMINAL GIRTH MEASUREMENT EVERY 2HRLY

6.URINE OUTPUT MONITORING EVERY HRLY