ACUTE PANCREATITIS

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CASE:

40 year old male came to the casualty with c/o pain abdomen since 5days,associated with vomitings.

HOPI:

Patient was apparently asymptomatic 5days back then he developed pain abdomen -diffuse(more in lower abdomen ),burning type ,radiating to back , aggravated with food ,relieved with medication a/w h/o vomitings since 1day ,4-5 episodes, non bilious ,non projectile,a/w intake of food.

No h/o fever /constipation/loose stools /burning micturition /dysuria/trauma.

Last passed stools 1day before ,passing flatus.

PAST HISTORY:

The patient had similar complaint one year ago, which was relieved on medication.

Not a K/C/O - DM, HTN, Epilepsy, Asthma, TB, CVA.

PERSONAL HISTORY:

1. Diet- Mixed
2. Appetite- Loss of appetite is present
3. Bowel and bladder movements- Regular
4. Sleep- Adequate
5. Addictions- H/o alcohol consumption since 20years; smoking 5-6  cigars per day since 20 years.
6. Surgical history-No h/o previous surgeries.

FAMILY HISTORY: 

Insignificant

GENERAL EXAMINATION:

The patient was examined in a well-lit room after informed consent was taken.

He is conscious, coherent, cooperative, well oriented to time, place and person.

He is well nourished and moderately built.

No Pallor, Icterus, Clubbing, Cyanosis, Koilonychia, Lymphadenopathy, Edema.

VITALS:

1. Temp-98°F
2. PR-77BPM
3. RR-18CPM
4. BP-140/100mmHg

• Spo2-98 at room air

SYSTEMIC EXAMINATION:

1. CVS- S1 S2 heard.
2. RS-BAE+,NVBS+
3. P/A- Shape-FLAT, tenderness PRESENT (diffuse), left hydrocele PRESENT.
4. CNS-INTACT

INVESTIGATIONS:

COMPLETE  BLOOD  PICTURE

LIVER FUNCTION TEST

SERUM LIPASE

LDH

RANDOM BLOOD SUGAR

ARTERIAL BLOOD GASES

RENAL FUNCTION TESTS

SERUM AMYLASE

ECG

ULTRASOUND ABDOMEN AND PELVIS

PROVISIONAL DIAGNOSIS:

ACUTE PANCREATITIS

Left  RENAL CALCULUS

TREATMENT:

Day-1

1)IVF -NS,DNS@80ML / HR

2)INJ.BUSCOPAN IM /STAT

3)INJ.DICLO 75MG /IM/STAT

4)INJ.PAN 40 MG /IV/STAT

Day-2 SOAP NOTES

S:

Pain abdomen decreased

No vomitings

O:

PR: 82bpm

BP: 160/100mmhg

Temp: 99F

RR:20cpm

CVS: S1, S2 Heard

Rs:BAE+

CNS:NFD

A:

Acute pancreatitis (2°to alcohol)with De novo HTN?

P:

1)INJ.PAN 40MG/IV/BD

2)IVF.NS RL @150ml/hr

3)INJ.ZOFER 4MG/IV/BD

4)INJ.TRAMADOL 1 AMP IN 100ML NS/IV/ BD

5)INJ.OPTINEURON 1AMP IN 100ML IV/OD

6)Tab.CILNIDIPINE 10MG/BD

7)GRBS MONITORING 4TH HRLY