27/M WITH CHRONIC PANCREATITIS

 A 27 years old,male patient electrician by occupation came to casuality with chief complaints of pain abdomen since 3 months. 

HISTORY OF PRESENT ILLNESS :- 

patient was apparently a symptomatic 3 months back then he developed mild diffuse abdominal pain associated with bilious vomiting which is ,projectile , containing food particles .

 Pain relieved temporarily on taking medications 

After a few days he again developed pain abdomen at the left hypochondrium region and the pain radiating to back , then he went to government hospital where he under went treatment but the symptoms didn't subsided 

So he went to a private hospital for which he took treatment but in the middle of treatment , he tested postive in the hospital , so he went to home isolation , were he approached a local rmp for the pain abdomen and covid .

After 5 days he tested negative in mid of January so he went back to the same private hospitaland under went treatment and his symptoms resolved and the doctors said that there may be chances of symptoms appear again.he didn't complain of any symptoms for the next days

Then after he developed pain again he now tolerated the pain for 3 days after which he came to our hospital with the chief complaints of pain abdomen at the hypochondrium and epigastric region which is intermittent , squeezing type of pain and the pain radiating to the back where there is the pricking type of pain and the pain radiating to the left shoulder tip 

The pain is aggrevated with walking, sleeping after a prolonged duration of sitting and relieved when he bends forward 

Patient when complaining of pain done cect abdomen 1/12 /2021 where the impression is pancreatitis with pseudo cyst 

PAST HISTORY :- 

NO H/O DM, HTN, asthma, epilepsy

No previous surgical history 


PERSONAL HISTORY 

Diet : mixed 

Appetite : decreased since 10 days 

Sleep : inadequate 

Bowel & bladder : regular 

addictions :- h/0 of alcoholic intake since 5 years , regular intake of alcohol and the there is a high intake of the alcohol . He stopped the intake of alcohol 4 months back 

FAMILY HISTORY : Not significant


ON GENERAL EXAMINATION : 


Patient is conscious, coherent, cooperative.



Pallor , Icterus,clubbing, cyanosis , koilonychia, edema are absent


VITALS 

Temp- Afebrile 

Bp-100/80 mm hg

PR- 84bpm

RR-16CPM

Spo2- 99% on RA

GRBS : 102


SYSTEMIC EXAMINATION : 


RS- bilateral air entry present 


Cvs-S1 S2 +


P/A - tenderness present in epigastric region and left hypochondrium 

rigidity present in the epigastric region and left hypochondrium 

no gaurding 

bowel sounds present 



CNS NAD 

GCS - 15/15

INVESTIGATIONS :- 

HEMOGRAM 

HB 10.5 GM/DL 

TLC #10,500 

N/L/E/M/B. #135/20/#40/05/00

PCV #32.5 

MCV # 82.7 

MCHC 32.6 

RBC. #3.93 

PLT. 5.5 

CUE :- 

ALBUMIN. NIL 

BILE SALTS AND PIGMENTS NIL

PUS CELLS NIL 

LFT :- 

TB 0.48 MG/DL

DB 0.17 MG/DL

SGOT 13 IU/L 

SGPT. 14 IU/L 

ALP. # 291 IU/L

Tp. # 5.9 gm/dl 

albumin. #2.92 gm/dl 

A/G RATIO. 0.98 


SERUM AMYLASE. 292 

SEROLGY. NEGATIVE 

CRP POSITIVE 2.4 MG/DL









*PROVISIONAL DIAGNOSIS: CHRONIC PANCREATITIS WITH PSEUDOCYST.

*TREATMENT GIVEN 

1) IVF NS /RL @75 ml / hr 
2) inj Tramadol 100 ml IV /TID 
3) inj pantop 40 mg iv/ OD 
4 ) inj zofer 4 mg iv/sos
5) plan to get CECT abdomen today and also gastro opinion .

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