A 37 year old male with pain in epigastrium
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A 37 year old male came with a Cheif complaints of pain in abdomen since a day
History of present illness
The patient was apparently asymptomatic 2 days back then he developed pain in abdomen around 1 am in the morning after passing stools and consumed alcohol ( around 250 ml) the pain increased its severity at 6am in the morning it was squeezing type and radiates from epigastric region to left hypochondrium.
H/o vomiting , non projectile and contents were food particles
Past history
H/o kidney infection 4 years back and treated on op basis
The patient was diagnosed with hypertension and gout 3 months back and used medication for 1 week and stopped
No H/o DM , TB , epilepsy , asthma
Personal history
The patient was a auto driver by occupation he goes to work at night after completion of his work he drink alcohol and comes to home eat and sleep.
He married 17 years ago and he had 2 children .
He drinks about 250 ml of alcohol daily since last 15 years
He smokes cigarettes 4 - 5 per day since 15 years
He takes about 10 packets of gutka a day since 15 years.
Family history
Not significant
General physical examination
The patient was conscious coherent cooperative moderately built and nourished well oriented to time place and person
Pallor - absent
Icterus - absent
Cyanosis - absent
Clubbing - absent
lymphadenopathy - absent
edema - absent
Vitals :-
Pulse rate - 86 bpm
Bp - 140/80 mm of Hg
Temperature - afebrile
Respiratory rate - 18cpm
SpO2 - 98% at room air
Systemic examination
CVS : S1,S2 heard , no lurkers
RS : BAE + normal bronchial vesicular sounds , no stridor
CNS : No focal neurological deficits
P/abdomen : abdomen was distanded
Tenderness over epigastriym and left hypochondrium and abdomen was guarded
Decreased in bowel sounds
Investigations
TB : 2.52
DB : 0.98
AST :45
ALT : 34
ALP :165
TP 8.2
Albumin :4.1
A/G : 1.03
Hemogram
HB :19.7
TLC : 10,100
Plt : 2.35lacs
N : 92
L: 6
Lipase : 94
Amylase : 268
RBS :203mg /DL
RFT
urea : 12
S. Creatinine : 0.9
Uric acid : 8.8
Ca +2 : 9.9
PO4 3- : 3.8
Na+ : 140
K+ : 3.7
Cl - : 98
HBsag , HIV , HCV - negative
Ultrasound
Bulky head and body of pancreas with altered echo texture
Grade 1 fatty liver
Provisional diagnosis
Acute pancreatitis
And de novo diabetes millitus
Treatment
1) nothing by mouth till further orders and ryles tube
2) IVF 2 NS / RL 100ml/hr
3 ) INJ PANTOP 40 mg /IV /OD
4 ) INJ ZOFER 4 mg /IV /SOS
5) INJ TRAMADOL 1 amp in 100 ml /NS /IV /BD
6) INJ THIAMINE 2 amp in 1 RS /IV/TID
7) Minutes vitals hourly
8 ) measure abdominal grith daily
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