65 male watchman by occupation came with the chief complaints of 
Abdominal pain since 5 days
Patient was apparently asymptomatic 1 week back then developed Abdominal pain early morning after intake of food which was sudden onset , non progressive , sqeezing , dull aching , continuous , No Radiation,  aggravating with intake of food , relieved after some time after vomiting or on lying on right lateral position , not relieving on medication
Vomitings 4 to 5 episodes associated with food particles , Non bilious , not associated with blood , Nausea is present , flatus is passed , passed stools 3 days back
H/o Fever since 5 days , low grade associated with chills and rigors , relieved with medication,  no diurnal variation
Pedal edema ( Grade 2 ) and facial puffiness is present since 1 month
No h/o decreased urine output , SOB,  orthopnea , PND , chest pain , palpitations , syncopal attack

PAST HISTORY  :
H/o HTN since 3 years and on MET 50 mg / Amlo 5 mg
No h/o DM , EPILEPSY , CVA , CAD , TB

FAMILY HISTORY : NAD

PERSONAL HISTORY : 
Diet - Mixed
Appetite - Lost
Bowel & Bladder - Regular
Sleep - Adequate
Addictions - known alcoholic ( 45 yrs/Regular/90-180 ml whiskey ) & smoker ( 2 chuttas / day / 45 years )

GENERAL EXAMINATION :
Edema of Feet - Present
No Pallor , Icterus , Cyanosis , Clubbing , Lymphadenopathy

VITALS :
PR - 64 bpm
BP - 140/90 mmhg
RR - 24 cpm

SYSTEMIC EXAMINATION :
P/A - Tenderness in Epigastric , b/l hypochondrium  , Right Lumbar. Liver & Spleen not palpable. B/l Inguinal Hernias

PROVISIONAL DIAGNOSIS :
???Acute Pancreatitis with CKD grade - 1
Treatment :
1. Tab. Pantop 40 mg PO / OD @ 8.00 AM
2. Tab. Met-XL-AM 50mg/5mg PO/OD 
3. Inj. Buscopan IV / SOS
4. Inj. Lasix 40 mg IV / BD
5. Tab. Nicardia PO
6. Tab. Dolo 650 mg

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18 year old student came with the chief complaints of Fatigue since 1 month SOB on exertion and physical activity since 1 month ( Grade -3 ) She was unable to do work on exertion. H/o chest pain which was relieved at rest. Palpitations positive. Pedal edema Grade - 1 since 7 days , Facial puffiness since 7 days , Nausea & Vomitings since 3 days associated with food particles & not associated with blood.  No h/o Abdominal pain , pale colored stools,  blood in stools H/o Tingling since 20 days observed at rest , no tingling at regular work Age of menarche - 12 years , 3/30 , Normal flow , No clots Dietary history - H/o taking food twice a day mostly pickles , She consumes all vegetables ( not adequate ) , Less fruit intake PAST HISTORY - No DM , HTN , CAD , ASTHMA , TB FAMILY HISTORY - NAD PERSONAL HISTORY -  Appetite - Normal Diet - Mixed Bowel & Bladder - Regular Sleep - Adequate Addictions - None GENERAL EXAMINATION : Pallor - Present , Edema of feet - Present No Icterus ,
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