A 65yr old male patient with acute on chronic necrotising pancreatitis
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Date of admission-September 15,2021
Chief complaint
A 65year old male patient complaints of vomtings and severe stomach pain since one day
History of present illness
Patient was apparently asymptomatic one month back.Then he had pedal edema,shortness of breath after doing minimal works and gradually developed distended abdomen.Since one day patient suffers from bilious vomtings of 10-12 episodes( first 4 episodes are white in colour and later are bilious)non-projectile type food as content with severe stomach pain.He also developed pain in the umbilicus radiating type to lower abdomen.On the day of admission he was diagnosed with denovo hypertension
Personal history
Patient had habit of consuming alcohol and cigar smoking since 20years.He had quit the habit of consuming alcohol and cigar smoking-since 6months
Patient has no loss of apetite
Mixed diet
Irregular bowel and bladder movements
Past history
Recovered from COVID-4months back
No history of diabetes
Family history
No similar complaints in the family
General Examination
Patient was conscious,coherent and cooperative
No pallor
No icterus
No cyanosis
No clubbing in fingers and toe
No lymphadenopathy
Pedal edema is present
VITALS:
TEMPERATURE AFEBRILE
Pulse rate: 96 BPM
Respiratory rate: 14 CPM
BP :200/90 mm Hg,
Spo2 98% at Room air.
CVS VITALS:
TEMPERATURE AFEBRILE
Pulse rate: 96 BPM
Respiratory rate: 14 CPM
BP :200/90 mm Hg,
Spo2 98% at Room air.
CVS
S1 S2 heard
Respiratory system
BAE+
Per abdomen
Distended abdomen,tenderness around the umbilicus epigastric and right hypochondriac region,bowel sounds present
pr
Provisional diagnosis
Acute on chronic necrotising pancreatitis with splenic vein thrombosis with mild bilateral pleural effusion with denovo hypertension
Investigations
CHEST X-ray
SERUM AMYLASE -397IU/L
SERUM LIPASE-107IU/L
BLOOD SUGAR-FASTING
TPR-graphic sheet
SERUM ELECTROLYTES
ABG
BLOOD UREA
SERUM CREATININE
PROTHROMBIN
BLEEDING &CLOTTING TIME
APTT
ECG
TREATMENT
1 IV fluids - NS, RL @ 75ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7.Inj MEROPENEM 1g /IV/BD
8. Tab Amlong 5mg po/od
QUESTIONS
1.Which stimulus triggered the patient to suffer from sudden vomtings and severe stomach pain??
2.Is the tenderness in the abdomen is due to the formation psuedopancreatic cyst ??
3.Why are amylase and lipase elevated in pancreatitis??
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