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Here is a case I've seen:
A 42 year old man was brought to the hospital by his wife with chief complaints of pain abdomen since 3 days and vomitings since 1 day.
History of present illness:
The patient was apparently asymptomatic 3 days back,then developed pain abdomen,diffuse, pricking type (more in left hypochondrium and epigastrium)radiating to back a/w sweating and burning sensation in epigastrium following an acute binge of alcohol(360 ml of whiskey) and vomitings since 2 days(5episodes/day) non bilious,non bloodstained,non foulsmelling, containing food particles.
Not passing stools since 2 days,passing flatus.
Increased alcohol intake since 15 days.
H/o burning micturition with hesitancy since 3 days.
No H/o trauma,LOC,fever, SOB,palpitations
PAST HISTORY:
Similar complaints 10 months back a/w acute alcohol binge,hospitalised for a week,diagnosed with acute interstitial pancreatitis,recovered with treatment.
Not a k/c/o HTN,DM,TB,COPD,epilepsy,
CKD,CHD
No H/o previous surgeries and blood transfusions
PERSONAL HISTORY:
Diet: mixed
Appetite: decreased
Sleep: adequate
Bowel and bladder movements: regular.
Addictions:
chronic alcoholic since 7 yrs (whisky,160ml/day,daily)
cigarette smoker since 8yrs (10/day),pt. Experiences irritability & constipation if he doesn't smoke......withdrawal +
Chews tobacco since 15 yrs(5 packs /day)
He's a lorry mechanic& lives in a joint family.
FAMILY HISTORY:
No significant family history.
DRUG HISTORY:
Not allergic to any known drug
GENERAL EXAMINATION:
Patient is conscious, coherent and cooperative
Moderately built and moderately nourished.
No signs of pallor, icterus, cyanosis , clubbing, koilonychia, generalised lymphadenopathy, bilateral pedal edema.
VITALS:
Temperature: afebrile
Pulse rate: 78 bpm,regular
BP: 140/90 mm of hg
RR: 15 cycles per min.
Sp02 : 98% at room temperature
GRBS: 215 mg/dl
SYSTEMIC EXAMINATION:
PERABDOMINAL EXAMINATION
Inspection -
Shape of abdomen: oval
Umbilicus - central
All quadrants are moving equally with respiration
Hernial orifices- free
No visible peristalsis
No engorged veins ,no sinuses and scars
Palpation -
No local rise of temperature
Soft and tenderness present in left hypochondrium and epigastrium
No palpable masses.
No guarding and rigidity.
No free fluid
Liver and spleen : not palpable.
Percussion -
Tympanic note
Auscultation -
Bowel sounds: normally heard and no bruit.
RESPIRATORY SYSTEM:
Position of trachea: central
No wheeze and dyspnea.
Bilateral air entry present.
Normal vesicular breath sounds heard.
No adventitious sounds.
CVS:
S1 and S2 heard.
No murmurs.
CNS:
Higher mental functions normal
All cranial nerves intact
Based on the clinical findings,the following investigations were sent:
CBP
RFT
RBS
FUNDOSCOPY - normal
Serum amylase,lipase
BUN
ECG
X RAY - CHEST AND ERECT ABDOMEN
USG abdomen
CECT ABDOMEN
Day 1
Day 2
Diagnosis:
ACUTE INTERSTITIAL PANCREATITIS WITH ALCOHOL DEPENDENCE SYNDROME IN WITHDRAWAL and TOBACCO WITHDRAWAL SYNDROME.
Treatment:
1.Ryles tube feeding ------ soft diet
2.INJ THIAMINE 100 MG IV IN 100 ML NS/TID
3.INJ OPTINEURON IN 100ML DNS/IV/OD
4.INJ PANTOP 40MG /IV/OD
5.INJ LORAZEPAM 2mg-----2mg-----4mg
(9am-----4pm-----9pm)
6.ointment THROMBOPHOB for L/A
7.IVF - RL,DNS@ 50ml/hr
Oral fluids upto 2 Lt/day
8.vitals monitoring 8hrly,I/O charting
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