1. A case of Abdoooooooominal pain DR. SUJITH OVALLATH. Neurologist

2. History Name : Ratheesh Age: 37yrs Payyannnur Occupation: Cook and Telephone Cable joint.

3. HISTORY OF ILLNESS In 2006 had an acute abdominal pain in the left lumbar region, lasted for 45 minutes. There was difficulty in micturarion. He was admitted in a local hospital. He was relived with analgesics. An Ultrasound abdomen was performed at that time.

4. Ultrasound showed left renal calculi, not causing any obstruction. He was treated by a Urologist and cured completely.

5. 16/05/2006 He was again evaluated for right flank pain. This time an ultrasound was repeated.

6. Bilateral Nephrolithiasis.

7. In 2007 He had recurrent abdominal pain. No vomiting. No melena. There was radiation of pain posteriorly and also to the left chest wall.

8. In between he underwent a upper GI endoscopy, which is reported as ? Antral gastritis. A stool examination on 2/10/07 reported oc cult blood- absent. Ova and cyst absent. Urine microscopy was normal.

9. 23 rd February 2008 He was admitted with recurrent abdominal pain. A repeat ultrasound showed no calculi or other abnormality.

10. 12 th October 2007 He was evaluated KMC Mangalore with lumbar spine X-ray.

13. X-ray reported as normal.

14. 19 th July 2007 He again had abdominal pain two to three times per week. A sigmoidoscopy was performed by a gastroenterologist in Dhanalakshmi Hospital.

15. Small internal hemorrhoids otherwise normal.

16. 19 th October 2008 He was evaluated at Pariyaram with a chest X- ray and a CT scan of chest and abdomen.

17. Chest x-ray

18. CT-Thorax

22. CT-Abdomen

24. Chest X-ray was normal. CT scan Abdomen was normal. CT scan Chest was normal.

25. History continued He has no arthritis malar rash, psychosis. Oral ulcer, genital ulcer, conjunctival congestion or heamaturia. General Examination: No lymph adenopathy. No vasculitic ulcers. No hyper pigmentation. Vitals are normal.

26. Examination of abdomen Scaphoid in shape. Soft non tender, all quadrants are moving equally with respiration. No hepatospleno megaly. No other mass palpable. Hernial orifaces are normal. External genitalia normal.

27. INVESTIGATIONS Hb : 15 gm/dl TC-5800 DC-N:62%,E: 2%,B:00%,M :01%,L : 35% and Platelet count 2.1.

28. A urine porphobilinogen estimation was performed.

29. Urine porphobilinogen was negative.

30. 18 th December 2009 A diagnostic investigation was performed.

31. Diagnosis: Lead poison

32. THANK YOU……