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A50 yr old female came to GM OPD with chief complaints of fever, vomiting, difficulty in breathing. HISTORY OF PRESENTING ILLNESS:- patient was apparently asymptomatic 2 weeks back then she developed fever of low grade with vomiting 4 episodes per day which is non-bilious, non-projectile. HISTORY OF PAST ILLNESS:- K/C/O- DM since 20yrs K/C/O- HTN since 20yrs. Not a K/C/O of TB, ASTHMA, EPILEPSY TREATMENT HISTORY:- METFORMIN since 20yrs TELMISARTAN since 20yrs PERSONAL HISTORY:- Diet- mixed Appetite- normal Bowel and bladder habits- regular Burning micturition No addiction FAMILY HISTORY:- Not significant PHYSICAL EXAMINATION:- #GENERAL:- No pallor No icterus No cyanosis No clubbing No lymphadenopathy Vitals:- B.p- 140/90mmHg Pulse-  Temp- Afebrile Respiratory rate- 18/min #Systemic examination:- CVS- S1,S2 heard           No cardiac murmurs           No thrills Respiratory system- dyspnoea present                                       No wheeze                                       Pos

Pt aged 45 years old male came to opd with chief complaints of vomitings ,abdominal pain and low grade fever since 1 day HOPI-:Patient was apparently asymptomatic 1day back then he developed sudden vomitings, abdominal pain and low grade fever PAIN-: Type-:dragging type of pain  Site -:epigastric region  VOMITING-:4-6 BOUTS IN A DAY         TYPE-:BILIOUS TYPE OF VOMITING No h/o-:constipation  No h/o-:loose stools ALCHOHOL HISTORY-:Since 5years with a gap of 1 year in between and again continuing since 3-4months  Quantity-:1beer/day HISTORY OF PAST ILLNESS-:                     similar complaints in the past 5 years ago N/K/C/O-: diabetes ,TB,asthma ,epilepsy,Hypertension  PERSONAL HISTORY-:          Diet-:mixed          Appettite-:normal           Bowel and bladder -:regular         Sleep-:normal          Addictions-: alcohol--->regular                                 1beer/day FAMILY HISTORY-:no similar complaints in family members  GENERAL EXAMINATION-: NO SIGNS OF -: PALLOR