Acute necrotising pancreatitis

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through a series of inputs from an available global online community of experts with an aim to solve those patient's clinical problems with collective,current,best evidence based inputs.

This e-log book also reflects my patient centered online learning portfolio and your valuable inputs in the comment box is welcome


September 14, 2021 
 Unit 2 admission


CHIEF COMPLAINTS : A 65 year old male came to casualty with complaints of vomitings and pain abdomen since one day. 

 HISTORY OF PRESENTING ILLNESS: Patient was apparently asymptomatic one day ago then he ate food that was prepared on previous day , which was followed by vomitings of 10 episodes bilious non projectile, food as content.the last vomitus was Black in color. 

He developed Pain abdomen around umbilicus squeezing type radiating to lower abdomen no aggravating or relieving factors. 

Shortness of breath - Grade 4

Fever subsided on taking medication 

 HISTORY OF PAST ILLNESS: Patient had COVID 19 PNEUMONIA 4 months back, No covid vaccine taken. 
 Patient attender started observing pedal edema and abdominal distension since one month , not associated with chest pain palpitations ,shortness of breath and increased urine output. 
No H/O D.M, TB, Epilepsy, Asthma, Hypertension. 

 PERSONAL HISTORY
Appetite - 
Diet- Mixed 
Decreased Bowel movements (constipation) 
bladder - Normal
Sleep- Adequate 
Addictions- history of alcohol intake since 20 years 
60 ml per day 
abstinence from alcohol and smoking since 4 months 
FAMILY HISTORY : insignificant

DRUG HISTORY: COVID treatment - 4 months back

SURGICAL HISTORY: none

 O/E:
Patient was examined in a well lit room, after informed consent.

He was conscious, coherent and cooperative.

No pallor 

No icterus 

No cyanosis

No clubbing

No koilonychia 

No lymphadenopathy

No generalized edema 

No pedal edema was observed.

JVP was not seen to be raised.


VITALS: On admission

TEMPERATURE AFEBRILE 

Pulse rate: 96 BPM

Respiratory rate: 14 CPM 

BP :200/90 mm Hg, 

Spo2 98% at Room air. 

Grbs 190mg %
 
  

 



SYSTEMIC EXAMINATION 

CVS S1 S2 HEARD

RS: BAE +

PA: DISTENDED ABDOMEN , TENDERNESS AROUND UMBILICUS EPIGASTRIC AND RIGHT HYPOCHONDRIAC REGION , BOWEL SOUNDS PRESENT




 


LAB INVESTIGATIONS:
Day 1











Day 2







Day 3







Day 4










Day 5









Day 6










CHEST X-RAY 14/09/21:







CECT ABDOMEN 18/09/21







USG


2DECHO


ECG









PROVISIONAL DIAGNOSIS: 

Acute Necrotising Pancreatitis with Splenic Vein Thrombosis with Mild B/L Pleural Effusion with Denovo detected HTN with Pancreatic ileus ( resolved )



Treatment:

Day 1:

1 IV fluids - NS, RL @ 100ml/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. Tab Amlong 5mg po/od

Day 2:

1 IV fluids - NS, RL @ 100ml/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. Tab Amlong 5mg po/Od

Day 3:

1 IV fluids - NS, RL @ 100ml/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

Day 4:

1 IV fluids - NS, RL @ 100ml/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

Day 5:

1 IV fluids - NS, RL @ 100ml/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

Day 6

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



Day 7:

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


Comments

Popular posts from this blog

88 yrs old Female came to casualty with......

Internship assessment of General Medicine posting

55 yr old male with pain abdomen