55 year old male with abdominal discomfort since 3days, involuntary movements 1episode since 1 day

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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.

    55 year old male, Resident of miryalaguda came to casualty  with chief complaints of 

   •Abdominal discomfort since 3 days 

   •Involuntary movements 1episode yesterday night followed by loss of consciousness and excessive sweating, giddiness since yesterday evening 

HISTORY OF PRESENTING ILLNESS:

    Patient was apparently asymptomatic 3days back then he developed abdominal discomfort since 3 days associated with belching and indigestion, insidious in onset 

     Patient had one episode of involuntary movements followed by loss of consciousness

     Patient was initially taken to local hospital where INJ 25 D was given and was referred to our hospital 

     H/o weight loss present 

PAST HISTORY:  Not a k/c/o DM, HTN , Epilepsy 

Known Alcoholic and smoker -Abstained from alcohol since a week 

PERSONAL HISTORY:

Diet- regular

Appetite - Normal

Bowel and bladder movement- regular

Addictions- alcoholic and smoker since 20 years 

FAMILY HISTORY:

Not significant 

GENERAL EXAMINATION:

Patient is  conscious,coherent, co operative 

Oriented to time ,Place, Person 

VITALS :

BP: 90/70mm hg

PR: 100 bpm

GRBS : 42 mg/dL

RR: 18cpm 

PER ABDOMEN EXAMINATION:

Tenderness present in Epigastrium, Left hypochondrium 

Bowel sounds present 

CARDIOVASCULAR SYSTEM:

S1, S2 heard

RESPIRATORY SYSTEM:

BAE present, NVBS 

CNS :NAD 

INVESTIGATIONS:

Hemogram:

Hb 8.7

TLC 10,400

Platelet count 1.40

N/L/M/E/B 85/05/08/02/00

LFT:

Tb 0.40

DB 0.20

SGOT 51

ALP 272

TP 4.9

Alb 2.84

A/G 1.38

RFT:

Urea 54

Creat 2.5

Sodium 133

Potassium 4.3

Chloride 98

RBS : 163 

CHEST X RAY :

Multiple well defined radio opacities in B/L lung fields likely metastases 

RIGHT hila is widened 

USG ABDOMEN :

E/O multiple hypoechoic well defined lesions in both lobes of liver largest measuring 33X34mm in segment 4A and 8, likely multiple liver abscess 

B/L Grade 2RPD 

6mm calculi noted in left kidney 

Right VUJ is dilated 

DIAGNOSIS :

?Hypoglycemia secondary to malignancy 

? Primary with lung and liver mets