Greetings of the day
Down the track of Memories
Another story from PGIMER Chandigarh
Years back , while working as a DM student.
Mr. Paul Singh (name changed) a 49 year old thin built person presented to our clinic at PGI Chandigarh with pain abdomen off and on for the past 12 months .Pain was intermittent and diffuse. He had lost around 14 kilograms of weight during this period.For these complaints he had consulted a lot of doctors. Apart from baseline investigations he had undergone UGI endoscopy twice, Colonoscopy once and all other investigations required for evaluation of an unintentional weight loss. Based on a few small lymph nodes in his CT scan abdomen , Anti tubercular treatment had been started by some doctor .The patient had continued treatment for 2 months without any relief and stopped it in despair. Ultimately Mr. Paul Singh had been started on anti depressants as no definite cause could be ascertained by the doctors.Finally he came to PGI.
That day Prof SK Sinha saw the patient in the new OPD block at PGIMER ChandigarhAfter a detailed history he scrutinized his thick file quite meticulously. Soon after his clinical examination Prof Sinha called us (DM residents) to his OPD room.“Please examine his abdomen individually but do not discuss it with each other “, Prof S K Sinha said in his usual soft tune.Three of us examined the patient. Yes guys, what did you find ? Prof Sinha inquired after sometime .Sir, the abdomen is soft , it is not distended and is not tender. There is no organomegaly. There is no free fluid .All of us had a similar description of our respective clinical examination findings .Prof Sinha went on listening keenly to our findings and finally glanced at all of us and smiled .Yes, he just smiled.There was a power behind his smile .His unique smile would play with one's adrenals and adrenaline thus leaching would leave the student's heart racing, motivating one to read and understand the subject. I must say, he would never scold anyone on rounds or during endoscopic procedures.Ibrahim! What are the steps of abdominal examination? Prof Sinha inquired.Sir, Inspection, Palpation, Percussion and Auscultation. " I replied.
Did u auscultate? Yes sir, the bowel sounds are normal, I replied.Prof Sinha, smiled again.
Now all of us were sure that things were not as straightforward as they seemed to be."Aisya to nahi chalaga" (Things won't work like this) .He whispered softly.Then he put his stethoscope on the patient's abdomen somewhere near the belly button. While holding the bell of the stethoscope he asked all of us to listen one by one .We did so.
"Shoo, shoo. shoo" there was a soft low pitched bruit(noise produced due to turbulent flow) audible there. Nevertheless, it needed a very good amount of concentration and focus in order to listen. This bruit was produced by the blood flow through narrowed segment of mesenteric vessel(Abdominal vessels feeding intestines) Patient's mesenteric angiography was done, narrowing demonstrated and a stent was placed across, to take care of the blood flow in the vessel .Following this procedure Mr. Paul Singh became perfectly fine and progressively gained weight. Thus Mr. Paul Singh had neither malignancy nor depression. He had mesenteric vessel insufficiency leading to on and off pain abdomen while eating. His narrowed abdominal vessels were not able to provide extra blood flow to the gut, normally required during eating. So he would get a pain abdomen and avoid eating. A vicious cycle of food pain relationship had started for the past one year leading to his weight loss.This phenomenon was picked up by our great Professor during a routine clinical examination. Kudos! By Wednesday of the fourth week Mr. Paul Singh came smiling and respectfully greeted Prof Sinha in his OPD. He thanked him wholeheartedly.All of us were thrilled to see him. He had no more a skinny look as he had regained his facial sheen. He had added 6kgms to his weight, just after a month post procedure.Above all, he was pain-free after a year long suffering. Great old days!
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