A 52 year old man presents to your clinic with complaints of having sudden onset of backache yesterday at around 5 pm.

A 52 year old man presents to your clinic with complaints of having sudden onset of backache yesterday at around 5 pm. He also says he had some retrosternal discomfort. He says he occasionally gets abdominal distension after taking meals .

You çheck his Blood pressure which is 140/90 mmHg.

A. Which investigations should be performed in this patient?

B. What are the findings in the X ray ?

C. How will you manage this patient ?.

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A. Investigations.

In the given history, 3 main problems highlighted are :

1. High blood pressure: in order to investigate this further, blood tests like RBS/ Random blood sugar to exclude Diabetes mellitus should be carried out. 

Also serum cholesterol levels to exclude Hypercholesterolemia and Urea/ Renal function tests to exclude kidney disease need to be done.

2. Retrosternal discomfort: in light of Hypertension, this could be due to a cardiac pathology and an ECG should be done , which in this case turned out to be normal. 

Also in light of Abdominal distension, Gastric cause should be excluded hence, H.pylori serology should be conducted, which again was negative in this case.

3. Backache: An X ray LSS / lumbosacral spiñe should be performed to exclude and spine disease.

B. X ray findings:

This X - ray erect abdomen and Lumbosacral spine shows distended bowel loop which can be due to gut hypomotility . The patient complained of constipation but not absolute bowel obstruction.

Also the lumbar vertebrae show osteoporotic changes and bony spur at edges .

C. Management:

Patient should be given treatment for hypertension, bone protection and gut hypomotility.

Medications like Amlodipine 5 mg OD, Adcal D3, Alendronate and motilium will be useful together with dietary advice.