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Case presentation:
A 55 year old male patient came with the complaints of
Chest pain since 3 days
Abdominal distension since 3 days
Abdominal pain since 3 days and decreased urine output since 3days and not passed stools since 3days
Hopi: patient was apparently asymptomatic 3 days back then he developed
chest pain in the epigastric region which is dragging type , on & off,no radiation.
Abdominal pain since 3 days continuous type,throughout the day, no radiating pain
Abdominal distention since 3 days
Diffuse,progressive associated with constipation ,nausea, decreased appetite and decreased urine output since 3 days and not passing stools since 3 days
Sob since 3 days increased onexertion,relieved on rest later progressed to even on rest
C/o chest palpitations
No h/o fever,cold,cough
No syncopal attacks
No c/o dysphagia,vomitings,hemetemesis,malena,yellowish discoloration of skin, no pale coloured stools,
Past history
K/c/o alcoholic since 30 years occasionally 2 -3 pegs whisky /once in 2 months
Smoker since 30 years chuttas/day,regular
Not a k/c/o HTN, DM,ASTHMA AND EPILEPSY.
PERSONAL HISTORY-
Appetite decreased
Constipation present
Mixed diet
GENERAL EXAMINATION -
Patient is conscious coherent co operative
Moderately built and nourished
Patient is short statured
pallor present
Icterus absent
No clubbing
cyanosis seen in upper limb
No lymphadenopathy
No pedal edema
Genu varum is seen
VITALS -
Patient is afebrile 98.4 f
BP - 70/50mm hg supine postion right arm
Pulse - 86bpm regular rhythm
RR - 28cycles per minute
SYSTEMIC EXAMINATION-
Per abdomen-
Inpection : Shape of the abdomen distended
No scars , sinuses ,no visible pulsations ,no visible peristalsis
Hernial sites intact
Palpation : no localised rise of temperature
Diffused Tenderness ,guarding and rigidity present.
No organomegaly
Abdominal girth 80cms
Percussion : resonant note all over abdomen
Auscultation : bowel sounds sluggish
Respiratory system - bilateral air entry present end expiratory wheeze present on both sides
Decreased breath sounds in IAA (RT side
Right side coarse crepts in MA,SCA
CVS -S1 and S2 heard
No murmurs
CNS -No abnormality detected
Ortho referral is done For Short stature and anterior excessive bowing of tibia both sides
And ? Diaphyseal dysplasia of both tibia
Surgery referral was done as patient was not passing stools and flatus
PR is done and patient passed flatus and manually evacuated hard pellets.
Sphincter tone is normal
Patient was not passing stools and DULCOLAX SUPPOSITORIES Were given stat and patient passed stools and
Ascitic Tap is done
And sent for analysis
Sugar 135 mg/dl
Protein 3.4 g/dl
Amylase 2407 IU/dl
Treatment
Ryles tube is placed
Foley's catheterization is done
NBM UNTIL FURTHER ORDERS
IVF 1.NS 1.DNS @ 75ML/HR
Inj PIPTAZ 2.25GM IV/TID
INJ METROGYL 500MG/IV/TID
INJ TRAMADOL 50MG IN 100ML NS /IV/OVER 1 HR/BD
INJ ZOFER 4MG/IV/BD
INJ PANTOP/40MG IV/BD
INJ LASIX 20 MG IV/BD IF SBP> 110 MM HG
NEBULIZATION WITH 2 RESPULES BUDECORT 12TH HOURLY
HEAD END ELEVATION
O2 INHALATION TO MAINTAIN SPO2> 92%
BP PR RR TEMPERATURE SPO2 CHARTING 4TH HOURLY
GRBS 6TH HOURLY MONITORING
Diagnosis:
Acute severe pancreatitis secondary to Gall stones with AKI with SIRS with mild Rt Pleural effusion with Subclinical hypothyroidism
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