50 year old male with chronic pancreatitis with mild ascites.

Chief complaints:-
A 50 year old male came, working as a daily wage labourer from Nagonda presented  to the casualty yesterday with the complaints of 
Pain abdomen since 1 week.

Hopi:- 
Patient consumes around 90ml of whiskey everyday since the past 10 years and he also smokes 1 pack of cigarettes per day.  He was apparently alright 7 years back then he developed pain abdomen around umbilical region which was non radiating and dull aching in nature, present throughout the day and wasn't relieved on sitting or bending forward. He went to a local hospital when in he was admitted for 4 days and continued to consume the prescribed medications for 1 week post admission. He thereafter stopped consuming alcohol for 7 months post admission. He later continued consuming alcohol. 1 month later he developed a similar episode of pain abdomen for which he used the medications prescribed as per his previous hospital admission.

4 years back - He experienced pain abdomen for which he consulted a doctor and he was diagnosed with renal calculi. 

Since the past 5 days, he has been experiencing pain abdomen, around the umbilical region, non radiating, not relieved on sitting posture it bending forward. Increased on food consumption and relieved on medications.


He is not a  known case of Dm, htn, CAD, asthma, tb, epilepsy.

Family history:-
No significant family history 
Examination:- 
No pallor, icterus, cyanosis, clubbing of fingers, lymphadenopathy, edema 
Malnourished 
Mildly dehydrated 
Temperature:- 98.4f
Pr:- 96 bpm
Rr:- 18cpm
Bp:- 150/70 mm Hg
Spo2:- 98%


Systemic examination:-
Per abdomen -
Inspection :
Scaphoid shape
Umbilicus central and inverted 
No scars, dilated veins, sinuses
Palpation:
Tenderness in umbilical region+ 
Percussion:
Tympanic note percussed
Auscultation:
Bowel sounds +

CVS:- s1 s2 heard and no added sounds
Rs:- BAE+ and NVBS 
Cns:- no abnormalities found 

INVESTIGATION:
USG REPORT: Chronic pancreatitis with mild ascites.
 Chest X-ray:

ECG report:

SERUM AMYLASE:217

SERUM LIPASE:132

RBS:129

Hemogram:
Hb: 15.3
TLC: 9800
PCV:43.3
PLATELETS:2.14

CUE:
ALBUMIN- POSITIVE
PUS CELLS: 4-5
EPITHELIAL CELLS:. 2-3

LFT:
TB:1.19
DB:0.30
SGOT:28
SGPT:12
ALKALINE PHOSPHATASE: 259
TOTAL PROTEIN:5.4
ALBUMIN: 3.6
A/G RATIO:2.0

RFT:
SERUM CREATININE: 1.0
SODIUM:136
POTASSIUM:4.3
CHLORIDE:96
BLOOD UREA:37


Provisional diagnosis:- 
Acute on chronic pancreatitis 


Treatment:- 
1.Ivf 20Ns 
     20Rl       @150 ml/hr
     20Dns
2. Inj. Pan 40mg iv 
3. Inj. Zofer 4 mg iv sos
4. Inj. Tramadol 1 Amp in 100ml Ns iv slow infusion 

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