Pancreatitis with Walled off necrosis
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Unit 5 : case
Dr. Praveen Naik( Ass. Professor)
Dr. Natasha mam( Pg Y3)
Dr. Zain Alam( Pg Y2)
Dr. Sashi kala ( Pg Y1)
Dr. Shailesh Patil( Pg Y1)
Dr. Sridevi ( Intern)
Dr. Mourya( Intern)
Dr. Shriya( intern)
Dr. Sowmya( Intern)
Dr. Anjali Vishwas(Intern)
A 30 YEAR OLD MARRIED MALE, WORKER BY OCCUPATION, CAME TO CASUALTY WITH COMPLAINTS OF EPIGASTRIC PAIN SINCE 10 DAYS, INDIGESTION ASSOCIATED WITH BURNING SENSATION POST MEALS SINCE 5 TO 6 MONTHS
PAIN IS SHARP, CONTINOUS, RADIATING TO LEFT HYPOCHONDRIC REGION, EPIGASTRIC AREA, AND IS TENDER ON PALPATION WHICH IS AGGARAVATED ON EATING
PATIENT IS CHRONIC ALCOHOLIC SINCE 9 TO 10 YEARS, STOPPED SINCE JANUARY 1 ST THIS YEAR, AS HE BAPTIZED AND SWORE TO NEVER DRINK AGAIN. HE USED TO DRINK SARA ( COUNTRY LIQUOR) 180 ML X2 ( 2 QUARTERS PER DAY). PATIENT ALSO TOBACCO CHEWING ADDICTION SINCE 10 YEARS WHICH IS QUITE EVIDENT BY HIS LOWE TEETH STAINING
NO COMPLAINTS OF FEVER, COUGH, COLD, VOMITINGS, HEADACHE,LOOSE STOOLS. NOT A K/C/0 HTN, DM, ASTHMA, TB, EPILEPSY, OR ANY OTHER SYSTEMIC ILLNESSES
NO HISTORY OF BLOOD TRANSFUSION
NO PAST SURGICAL HISTORY
PERSONAL HISTORY: MARRIED, WORKER
CONSUMES MIXED DIET, APPETITE IS NORMAL, BOWEL AND BLADDER MOVEMENT S REGULAR
ADDICTIONS:ALCOHOLIC 10 YEAR HISTORY, STOPPED NOW
HAS TOBACCO CHEWING ADDICTION SINCE 10 YEARS
NO KNOWN DRUG AND ALLERGIC HISTORY
FAMILY HISTORY: NOT SIGNIFICANT
GENERAL EXAMINATION:
NO PALLOR, ICTERUS, CYNOASIS, CLUBBING, GENERALISED EDEMA AND LYMPHEDENOPATJY
VITALS:
TEMPERATURE: AFEBRILE
BP:120/100 MM HG
PR: 62 BPM
RR:22CPM
GRBS:92 GM/ DL
Spo2:100 PERCENT ROOM AIR
ON EXAMINATION:
PER ABDOMEN:SOFT, NOT DISTENDED, TENDERNESS ELICITED AT LEFT HYPOCHONDRIUM, NO GUARDING, NO RIGIDITY, BOWEL SOUNDS PRESENT
CVS EXAMINATION:S1 S2 HEARD, NO ADDED MURMURS
CNS EXAMINATION: NO ABNORMALITIES DETECTED
RESPIRATORY SYSTEM EXAMINATION: ,BAE PRESENT, NVBS PRESENT
INVESTIGATIONS:
HEMOGRAM
SHOWING PANCREAS BULKY IN SIZE, 37x37 MM PSEUDOCYST WITH PANCREATITIS
Xray abdomen Erect
ECG
CECT abdomen
http://pacs.kaminenihospitals.com:99/WADO/MetaData?aet=AEKIMS&studyUID=1.2.392.200036.9116.2.6.1.3268.2051739142.1613801395.353155&sessionKey=87fe3d46-2a44-4487-aa1f-fc1f865677fa&src=Vijaya
DIAGNOSIS: PANCREATITIS WITH WALLED OFF NECROSIS
TREATMENT
Day 1:
PATIENT COMPLAINED OF PAIN IN EPIGASTRIC REGION
NO FEVER SPIKES
STOOLS NOT PASSED
PATIENT IS CONSCIOUS COHERENT, COOPERATIVE
ON Examination:
TEMP:98 Degree F
BP:120/90 mm HG
PR:70 bpm
RR:20 cpm
PER ABDOMEN:TENDERNESS PRESENT IN UMBICAL AND PARAUMBILICAL REGION
BISHOP SCORE:0/5
Rx:
NIL BY MOUTH
IVF:RL DNS 2.NS @ 100 ml / HR CONTINOUS INFUSION
INJ. PAN 40 MG /IV/OD
INJ ZOFER 4 MG/IV/TID
INJ TRAMADOL 500 MG/ IN 100 ML NS
INJ OPTINURON 1 amp IN 100 ML NS/IV/0D
TEMP AND BP MONITORING
VITALS MONITORING AND STRICT I/0 AND OU CHARTING
Inj CIPROX 500 MG/IV/OD
Day 2:
PATIENT COMPLAINED OF PAIN IN UMBILICAL REGION
PATIENT IS CONSCIOUS COHERENT, COOPERATIVE
ON Examination:
TEMP:98 Degree F
BP:120/70 mm HG
PR:65 bpm
RR:21 Cpm
Rx:
NIL BY MOUTH
IVF:RL DNS 2.NS @ 100 ml / HR CONTINOUS INFUSION
INJ. PAN 40 MG /IV/OD
INJ ZOFER 4 MG/IV/TID
INJ TRAMADOL 500 MG/ IN 100 ML NS
INJ OPTINURON 1 amp IN 100 ML NS/IV/0D
TEMP AND BP MONITORING
VITALS MONITORING AND STRICT I/0 AND OU CHARTING
Inj CIPROX 500 MG/IV/OD
GRAPHICAL TIME LINE
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