Respected Doctors Following The Brief Ailment History Of My Wife A Female Aged 49 Years03 Elective Csections Known Case Htn For Last 05 Years Taking T

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SYED TIRMIZI Says:


respected doctors, following the brief ailment history of my wife, a female, aged 49 years,03 elective c/sections, known case of htn for the last 05 years, taking tab. adalat la 30 mg. 01 daily and tab. mepresor 100 mg. 01 daily irregularily.
now she has the h/o, black stools (melena) since december, 2009,with c/o, persistant nausea,gases(flatulance),pain centre abdomen and very rare vometing.it is very important to describe that green coloured stools and large amounts of mucous were observed for 01 month approx. before black stools began.the investigation history is as under
USG-----(17/12/2009)------- (Normal findings)
occult blood (15/2/2010)------ (+++)
USG-----(17/2/2010)------(increased echogenicity,fatty
liver)
Upper GI Endoscopy-- (17/02/2009)--(moderate antral
gastritis)
osophagus--normal,Stomach--moderate antral gastritis,no
active bleeding, pylorous,duodenal bulb--normal,D2 normal
ECG---(17/2/2010)----Normal
Barium meal enema---(18/2/2010)----Free flow of contrast
seen in the large gut.A WELL DEFINED FILLING DEFECT IS
SEEN IN THE DESCENDING COLON CLOSE TO THE SPLENIC FLEXURE
BUT THE NEXT DAY, SHE PASSED A JELLY LIKE MATERIAL IN HER STOOL.UNFORTUNATELY, SHE DID NOT COLLECT IT FOR INVESTIGATION.
Barium meal follow through--(20/2/2010) ----normal study,
no filling defect seen.
Endoscopy by a gastroenterologist--(22/2/2010)Normal
upper and middle third,lower third showed lax les para
esophageal hernia with free reflex.
Stomach---Pan gastritis more marked in antrum
duodenal--normal bulb and descending duodenum
Colonoscopy---(22/2/2010)--- normal examination
GI bleed scan----(4/3/2010)---No scintigraphic evidence
of GIT bleeding.
99m Tc meckek study--(13/3/2010)---no scintigraphic
ectopic gastric mucosa and hence meckle diverticulum.
Lower GI endoscopy---(30/4/2010)---anal canal/rectum,
sigmoid colon--there is no contact bleeding/polyp/
stricture.
colon---descending cilon, transverse colon and
ascending colon are normal.
caecum----normal
conclusion---normal colonoscopy
C.T ABDOMEN AND PELVIS---mild degenerative changes are
noted in the spine.
No significant abnormality seen
Upper GI endoscopy---(4/5/2010)---Normal
esophagoduodenoscopy, bowl preparation--fair.
Duodenal Biopsy----(4/5/2010)---duodenal mucosa showing
no histopathological changes.
Anti Transglutaminase-1gA 6.1 U/ml (5/5/2010)--Normal
Anti T ransglutaminase-1gG 5.0 u/ML--(5/5/2010)--NORMAL
Now she complaints moderate to severe pain in centre abdomen
with nausea, very dark black stools in huge quantities,2 to 3 times a day.her H.B.level was at 5.6gm/dl,after 03 pints of blood transfusion it raised at 10.2 gm/dl.
the concerned doctors suggested Leparoscopy. On february8,2011 and as the consequences of laparoscopy, the meckel’s diverticulectomy, truncal vagotomy & pyloroplasty were done in a renowned hospital. After the surgery,the following signs & symptoms accompanied with the patient.
1. After every intake in small or large quantities, palpitation occurs @ 110 to 120 beats per minute for the period of ½ to 1 hour associated with anxiety, discomfort, heaviness & mild to moderate pain in abdomen & epigastrum.
2. Usually this condition disappears after passing 1 or 2 large watery stools.the patient feels better, comfort with some feeling of general weakness.
3. During surgery, unfortunately the splenic artery was cut down but now a days ,the spleen has been survived naturally. To maintain blood pletelets in normal limits tab. Ascard 01 daily is being taken but irregularly because the patient complaints general weakness after every in take of tab. Ascard .
Now the condition of the patient is as same as above cited. But the concern is that the patient complaints dark green stools for the last 3 or 4 days. This is the same condition when in the very beginning of the history of the patient, the black stools were found such as after green stools.
At the end , i request you to look into the matter thoroughly and let me know your expert’s opinion regarding investigations, surgery conducted and how to treat the patient in future (please suggest treatment) ?

- With best wishes and hope of early reply



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