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 

Comments

Post a Comment

Popular posts from this blog

A55year old male with ? Nephrotic syndrome Known case of Hypertension since 10 daysAnemia under evaluation.

Image
This is Online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent .Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.  CASE DISCUSSION:  •55 year old man, owns a restaurant at choutuppal presented with the complaints of Bilateral lower limb swelling since 1 month Reduced urine out since 20 days Abdominal distension since 7 days Scrotal swelling since 4 days Patient used to previously work as a farmer  and later in 2004 he and his wife started running their own restaurant at Choutuppal. He is a father of 2 children.   22 years back:  He got diagnosed with pulmonary kochas for which he used ATT for 6 months   1 month back :  He first developed left lower limb swelling extending upto his ankle and he later gradually developed swelling of h
Read more

A 50 year old male with acute Gastroenteritis

UNIT 4 ADMISSION:- A 50 year old male came to casuality with complaints of Vomiting since 2 hours Loose stools since 2 hours HOPI: Pt was apparently asymptomatic 2 hours back then he had vomitings 4-5 episodes, nonbilious in nature,non projectile, food particles as content and h/o loose stools since 2 hours,watery in consistency,  No h/o fever,cold,cough, burning micturition  No h/o pain abdomen Past history: No similar complaints in the past He is a a k/c/o HTN since 3 years and on Tab.telma 20 mg Po/od and  Depression and on tab.sizdon 25mg Po/od Not a k/c/o DM type 2/ASTHMA/EPILEPSY/TB He is a non alcoholic and non smoker O/E:  Pt is conscious , oriented to time , place , person   No pallor , Icterus, cyanosis , clubbing, lymphadenopathy , edema.  Vitals:  Temp - 98.7 BP - 90/60mm of hg PR - 112 bpm  Spo2 - 96%at RA  RR- 18cpm GRBS - 149 mg/dl  Systemic examination:  Cvs: s1 s2 present , no murmurs Rs: BAE present, normal vesicular breath sounds present.  P/A: soft, non tender 
Read more