14 year old male with pain abdomen and vomitings

December 01, 2022

This is online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs .This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

A 14 year old boy studying in 8th standard came with complaints of vomitings and abdominal pain since November 2022

At the age of 8 months

Patient developed diarrhoea on and off for 3 months and was treated for the same

At the age of 5 years

He developed cough and cold and was diagnosed to have asthma and used medication for 3months(inhaler)

Since then he had recurrent attacks of cold and cough in winter

At the age of 8 years

He noticed a swelling in the midline of the neck and was having difficulty in swallowing, then was diagnosed to have hypothyroidism and was kept on medication(Thyroxine 200mcg)

At the age 12years

Patient developed chicken pox and it resolved but scars are seen

In last week of December 2021

Patient developed vomitings and jaundice, came to our hospital. Then was found to have spleenomegaly and was kept on steroids and were tapered for 3 weeks

In August 2022

Patient noticed palpable mass in left upper quadrant while taking bath which is increasing in size and painless

In November 2022

Patient developed vomitings which are bilious and non projectile and abdominal pain which is dragging type in left upper quadrant and not radiating and was taken to NIMS and other hospital(Pranahitha hospital) was told spleenectomy is needed for the patient.

Vaccinations were given and analgesics for pain abdomen were given and was discharged

Patient was taken to NIMS for suggestions about spleenectomy and there he was suggested the same

Then the patient was brought here. While he was here, 1 week after the admission he developed pain abdomen, and fever from 5days

Past history:

No history of blood transfusion

Personal history:
Diet :mixed
Sleep: adequate
Appetite :normal
Bowel and bladder movements:regular
No addictions
Daily routine:he is studying in 8th standard in Gurukul school he wakes up at 4am, gets ready do some exercises and running, he takes the thyroid tablet and later he have his breakfast then goes to school and attend classes, he have his lunch at 12pm and and attend his classes until 6pm and then he plays for a while and have his dinner and goes to sleep at 9pm.

Family history:

He is a 4th order child born to a consanguinity married couple and had one elder sister and also have two elder brothers

Elder sister of patient had developed spleenomegaly at the age of 2years and had multiple blood transfusions until 3years of age. She was adviced to have spleenectomy but did not underwent any and she died at the age of 5years