37M

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A 37Y/M came to casuality with

 

C/O pain abdomen since 4 days

associated with nausea and vomiting 

HOPI:

Patient was apparently normal 4 years back then he started alocohol consumption 90ml once in 4-5 days , toddy comsumption everday.

2yrs back H/O pain abdomen and admitted in hospital for alcoholic liver disease and got discharged then again started drinking alcohol.

3 months had similar complaints and admitted for ? pancreatitis 

10 days back patient had alcohol binge presented with C/o pain abdomen a/w nausea and vomiting 

patient is not a known case of DM/HTN 

General examination :

Patient is concious,coherent,cooperative well oriented to time and place 

No palor,icterus,cyanosis,clubbing edema,lymphadenopathy 

Temp : afebrile 

pr :70bpm 

bp:110/70mmhg

spo2:98% at RA

Systemic examination : 

CVS: 

S1S2 Heard

no thrills and murmurs

RS: 

BAE+

NVBS+

Per abdomen :

Soft 

 tenderness present in left hypochondriac region

Pain in the back of left shoulder on palpation of left hypochondriac region

no palpable mass 

bowel sounds + 

CNS: 

NFND 

CBP 

hb : 12.1

TC:7800

PC:3.6lakh

PCV: 36.3

RFT :

Sr.cr:0.7

sr.Ua:3.9

sr.ur:29

sr.na+:144

sr.k+:4.1

sr.cl-:102

LFT : 

TB:1.34

DB:0.28

ALP:202

AST:10

Amylase :996

serology- negative 

Clinical images:

Investigations:

provisional diagnosis :  ACUTE  INTERSTITIAL PANCREATITIS MINIMAL PERISPLENIC LOCULATED FLUID COLLECTION.MILD ASCITES,LEFT MILD PLEURAL EFFUSION.LEFT RENAL SUBCAPSULAR HEMATOMA.

HYPODENSITY OF RENAL POSTERIOR CORTEX ?RENAL ISCHEMIA/IMPENDING INFARCT

Treatment given :

IVF -2• Ns @100ML/HR

          2•RL

INJ.PAN 40MG IV/OD 

INJ.THIAMINE 1AMP IN 100ML NS IV OD

INJ.TRAMADOL 1AMP IN 100ML NS IV/OD 

INJ.ZOFER 4MG IV/SOS

BP/PR/TEMP MONITORING