29-04-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
OPD now: Project optimizing clinical complexity in abdominal pain @PPM3 @PPM4 @SE this patient's story is similar to the one I shared about following up since 2005!
40F with problems since 1999 with pregnancy, post cesarean, gall bladder pain and lymph node issues
1995 Marriage at the age of 12 (while studying in 7th standard, husband was in 10th)
1999: pregnancy with right hypochondrial pain and vomiting everday with weight loss till delivery by LSCS and yet pain abdomen didn't relieve. Referred to Hyderabad pvt hospital where lap cholecystectomy was done on December 1999 and she was alright till 2003 after which she noticed recurrence of pain abdomen and vomiting along with weight loss and cachexia! Went to OH in 2004 on OP basis and after one admission in 6/11/2004 to 26/11/2004 they gave up and asked her to go home and die! She went to GH and there they did an exploratory laparotomy and found a CBD structure which was rou-en-yed by joining the CBD with the jejunum. Then they also removed a lymph node from the abdomen that sent her on an oncology lymphoma wild goose chase @PPM5
From 2005-2012 she was alright but developed similar symptoms of intermittent intestinal obstruction with pain abdomen, vomiting and abdominal distension which would last 24 hours and keep recurring every week till 2025 and she has avoided all marriage functions that involves eating!
[29-04-2025 13.01] PPM 3: Based on the history, could be an unresolved pathology she has from beginning (since pregnancy) or a complication of the surgery(stricture) performed, or adhesions formed from the previous surgeries.
[29-04-2025 13:14] PPM 1: Can talk to the patient advocate here.
[29-04-2025 13:44] PPM 3: OK sir
[29-04-2025 15.23] PPM 1: Reviewed her residual GB stump with a stone just now with POCUS
[29-04-2025 15:25] PPM 3: As she is S/P Cholecho- jejunostomy is there a possibility of Gallstone ileus?
[29-04-2025 16:17] PPM 1: Would that cause intermittent pain and vomiting every week?
[29-04-2025 16:48] PPM 3: https://pmc.ncbi.nlm.nih.gov/articles/PMC3494548/
[29-04-2025 16:49] PPM 3: It is possible sir but mc presentation is acute
[29-04-2025 17:02] PPM 1: Talk to the patient's advocate tomorrow and see if it matches her history
[29-04-2025 17:09] PPM 3: okay sir
[29-04-2025 19:46] PA: Energy intake - April 29, 2025
1. Had coconut water at 5:30PM
[29-04-2025 20:06] PA: 2. Tea at 8PM
[29-04-2025 21:39] PA: 3. Had rice with cucumber curry as dinner at 9PM.
[30-04-2025 08.42] PPM 3:
[30-04-2025 09:35] PPM 1: Thanks @PPM 3
@PPM 6 please delete the previous documents shared by the patient advocate above to protect the privacy of her patient and please make us admin.
[30-04-2025 10:08] PA: Came to kamineni hospital Narketpally for scanning and tests.
[30-04-2025 10:29] PPM 1: Today again? Perhaps not?
[30-04-2025 10:30] PPM 7: She's has come and having the fluids required to get the scanning
[30-04-2025 13:34] PPM 1: @PPM7 please ask her to meet in ICU at 2:30 PM
[30-04-2025 13:35] PPM 1: Please meet me at 2:30 PM in ICU @PA.
[30-04-2025 16.47] PPM 1: Consistent with yesterday's bedside ultrasound findings here, today's CT shared by @PPM8 reveals corresponding CT images showing the gall bladder fossa containing a calcified gb lith (they are rarely radiolucent!) with the remnant of the GB too! An MRCP MRI has been planned for better visualization of the same.
[30-04-2025 18:26] PA: Energy intake: April 30, 2025
1. Morning 1.5 litres of water 9am to 2pm
2. 3 Idli at 3pm
3. Tea6;30pm
[30-04-2025 19:18] PPM 1: Hope she's feeling better now?
[30-04-2025 22:09] PPM 7: She had loose tools 2-3 times
[30-04-2025 22:10] PPM 7: 3. Dinner- rice with brinjal curry
[30-04-2025 22:10] PPM 7: Doctor, can you please let me know any particular food to avoid pain
[01-05-2025 07:22] PPM 1: Please share the patient's food plate images and please share all that she's eating. After first evaluating the current intake for a few weeks, we shall suggest changes that can help her
[01-05-2025 09:05] PPM 7: Noted. Certainly
[01-05-2025 09:34] PA: 9:30 1 glass water
9:35 tea
[01-05-2025 16:35] PPM 1: Only tea since morning?
[01-05-2025 22:07] PPM 1: https://medicinedepartment.blogspot.com/2023/10/healthy-harvard-plate-in-telugu.html?m=1
[02-05-2025 08:38] PPM 1: Was there any symptoms after eating this rice with chutney yesterday? Please ask your patient to share all her symptoms and activities hourly if possible
[02-05-2025 09:58] PA: Traveled to kamineni Narkatpally now for tests.
[02-03-2025 10.31] PA: Had Dosa for breakfast
[02-05-2025 11:33] PPM 1: Reviewing with CT abdomen now. @PPM9 can we work out the Web 3.0 magic here taking into account all that has transpired previously in this group logged in her case report above and also take into account the current CT abdomen findings where the only new finding appears to be devlopment of stones in the choledochojejunostomy tract as well as gall bladder stump.
[02-05-202513.19] PPM 1: Here's the intern's share of his discussion with the radiologist who was kind enough to explain to him with a diagram.
[02-05-2025 14.45] PPM 1: The current gastro plan for her.
[02-05-2025 15.43] PA: Lunch with curry
[02-05-2025 18.15] PA: Had coconut water.
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