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Sudden onset of chest pain associated with vomiting warrants that a cardiac cause such as IHD (Ischemic heart disease) be excluded primarily. A baseline EKG should at least be done, ideally during the onset of such pain. An ETT can be planned if changes are found or other risk factors are positive.

Constipation, hard stool passage can erode the mucosa and cause bleeding streaks. Stool softeners should be used with adequate fluid intake. If it persists then a stool routine exam plus for ova and parasites should be done.

In the epistaxis (bleeding from nose ) local examination to look for bleed from an area called Little's area rich in vessels should be looked for.

The fatigue and dizziness can be associated with a number of conditions and one cant pinpoint them to a certain diagnosis. On clinical examination and blood work these can be correlated with conditions like Anemia. Complete blood count and basic metabolic panel can be advised in this regard.


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Dr. M.S. Khalil

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