Gm

January 05, 2021

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CASE PRESENTATION:

A 18yrs old female student, unmarried came with c/o

Fever a/w chills since 15days

Pain abdomen since 15days

Excessive menstral bleeding

Pt was apparently asymptomatic 3 yrs back when she started her work in the feilds for the first time in 2017 when she was in 10th standard, she managed to go to fields for farming and planting in their paddy fields working 6hrs a day in feilds(10am-4pm) with a rest of 1 hour. Started observing bleeding through nose which started suddenly when she sneezed and with flow of blood she herself managed nose pinch for 3-5min where bleeding stops. Then she observed those episode aren't frequent, roughly around around 5-6 per year, with last episode 8 months back.

1 yrs back, H/o back pain since 1yr lasting for 6 days irrespective of her periods . (She can do her daily routine work )back radiating to front .

At the age of 16yrs, 16th in the month of March attained menarche, she elaborated that first 2-3cycles were regular with normal flow and duration, then she had infrequent cycles 2/months lasted for 7 days/cycle, high flow ,clots present ,not associated with dysmenorrhea changes 3pads/day till 7 days.

In month of November in 2018, she got fever high grade associated with chills and rigors, then she admitted in hospital in minjalaguda, she was said to hb%-2gm, platelets-35,000, WBC-decreased and told to have typhoid fever then 1PRBC of blood transfusion is done and no other records are available. Her post transfusion hb was 4gm%,she denies any use of iron supplements/B12 injections at the time of discharge.

Pain in abdomen since 15 days , diffuse type not associated with nausea, vomiting and loose motions associated with feeling of incomplete defecation,tenesmus present.

H/o streaky blood in stools

H/o easy fatiguability palpitations, SOB on exertion since 4 yrs. In year of 2016 ,had history of fever and icterus and took herbal medicine.

No h/o DM, HTN,Asthama, TB,CAD.

Appetite decreased since 7 days due to fever

Mixed diet

Adequate sleep

Regular bowel and bladder movements ,constipation occasionally monthly twice.

No addictions

General Examination:

Patient is c/c/c. Well oriented to t/p/p

Moderately built and well nourished

Pallor - present