A 50 yearold male with pain abdomen.

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A 50 year old male,labourer by occupation from Miryalguda came to casualty with complaints of pain abdomen since 2 days and was associated with nausea.

TIMELINE OF EVENTS:

6 years back:

Patient was apparently asymptomatic 6 years back until he lost his wife due to which he started drinking alcohol(90-180ml) everyday and used to do his routine work.

2years back:

Patient complained of tingling sensation on both upper and lower limbs for which he was taken to local hospital.Incidentally creatinine was raised  to 2.4 mg/dl and since then he was on medication and stopped since one year.

2 days back:

Patient complained of squeezing type of abdominal pain which was sudden in onset.It was continuous,  non radiating and was  associated with nausea.It was aggravated on taking liquids and in supine position  and releived on bending forward.He was taken to a localhospital where his pain was releived after taking medication.He was put on nasogastric tube and gastric contents were collected.They referred him to our hospital.

1 day back:

He was referred to our hospital  with burning sensation in epigastrium.Patient had 1 episode of vomiting which was bilious .Patient also had heaviness in the chest 1 day back.

No c/o fever, pain,cold ,cough.

PAST HISTORY:

Not a k/c/o DM,HTN,CAD,CVA, Epilepsy.

FAMILY HISTORY:

Patient relatives had similar renal problem.

GENERAL EXAMINATION:

On examination patient is conscious, coherent, cooperative 

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema 

VITALS:

Temp-98.4 degrees F 

PR-94 Bpm 

RR-19Cpm 

BP:150/90mm Hg on admission 

Spo2:96% at room air 

GRBS-133 Mg% 

Systemic examination:

Per abdomen:

Diffuse tenderness is present

Rs:

Bilateral air entry is present.

Normal vesicular breath sounds are heard.

CVS:S1S2+ 

CNS: Normal

Diagnosis -

Acute Pancreatitis

INVESTIGATIONS: 

Hemogram:

Hb-17.3

Tlc-17,800

PCV-48.9

MCV-81.5

MCH-28.7

MCHC-35.2

RBC COUNT-3.03 

Ptc-2.38

Normocytic normochromic anemia with neutrophilic leucocytosis.

Sr Amylase-71IU/L

Sr Lipase-28 IU/L

Serology:Negative

LFT:

T.bil-1.50 

D.bil-0.7

SGOT:40

SGPT:44

ALP-174

T.protein-7

Albumin-4

A/G-1.38

CVE:

Specific gravity:1.010

Albumin:positive

Puscells:3-6

Epithelial cells:2-4

Bile salts:negative

Bile pigments:negative

Amorphous deposits:negative

ECG:

CLINICAL IMAGES:

DIAGNOSIS:

Acute pancreatitis

TREATMENT:

1)INJECTION CEFTRIAXONE 1g/IV/BD

2)INJECTION PAN 40mg IV/OD

3)NBM till further orders

4)IVF -125ml/hr 

 

5)INJECTION ZOFER 4mg/IV/TID

6)THIAMINE 1 ampoule

   100ml NS/IV/TID

7)Abdominal girth monitoring 4th hourly

8)BP/PR/RR /SPO2 charting