ACUTE PANCREATITIS SECONDARY TO ALCOHOL CONSUMPTION WITH MINIMUM PLEURAL EFFUSION

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A 30 year old male came to the opd with complaints of pain abdomen in the epigastric region, umbilical region,left hypochondric region relieved by sitting forward.                                                                          H/O vomitings 2 episodes,non bilious,non projectile containing food particles                                      Passing flatus +                                                              H/0 alcohol intake on Friday and Saturday.            No other complaints

No h/o similar complaints in the past

No h/o DM,HTN,TB,Asthma, epilepsy,CVA,CAD

Personal history:

Appetite: normal

Diet:mixed

Bowel and bladder movements: regular

No known allergies

history of alcohol intake from 15 years , 180 ml per day , abstinence from 1 month.

CAGE criteria: score - 1

Have you ever felt you needed to Cut down on your drinking - no

Have people Annoyed you by criticizing your drinking - no

Have you ever felt Guilty about drinking - no

Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover - Yes

No significant family history

GENERAL EXAMINATION:

patient was examined in a well lit room after taking consent.

 

Patient is conscious, coherent and cooperative.

pallor - absent 

icterus - absent

Cyanosis - absent

Clubbing - absent

No lymphadenopathy 

No pedal edema.

Vitals:

Temperature: 98.2F

BP :170/90 mmHg

PR : 98bpm

RR: 22 cpm

SpO2 99% in room air

SYSTEMIC EXAMINATION:

CVS: S1 S2 heard

         No thrills and murmurs

RS : trachea central

        BAE- present 

        Normal vesicular Breath sounds

CNS: No focal neurological deficits

P/A : soft , non tender

          Umbilicus - inverted

All quadrants moving equally with respiration

Scars- No scars seen

          No palpable spleen and liver

          Normal bowel sounds heard.

INVESTIGATIONS:

Heamogram:

Hemoglobin:17.8 gm/dl

Total count:10,500 cells/cumm

Platelet count:1.64 lakh/cumm

Blood urea:24 mg/dl

Liver function tests:

Total bilirubin-2.18 mg/dl

Direct bilirubin-0.83 mg/dl

AST-62 IU/L

ALT-28 IU/L

Alkaline phosphatase-112 IU/L

Total protein-55 gm/dl

Albumin-2.7 gm/dl

A/G ratio-0.98

Serum Amylase:1,244 IU/L

Serum creatinine:0.8 mg/dl

Serum electrolytes:

Sodium-137 mEq/L

Potassium-4.4 mEq/L

Chloride-98 mEq/L

Troponin I: negative

ECG:

CHEST X Ray:

TREATMENT:

DAY 1:

1.IVF-NS,RL @150 ml/hr
2.inj.pan 40mg iv/bd
3.nbm till further orders
4.inj.Tramadol 1 amp in 100 ml NS iv/bd
5.inj zofer 4mg iv/bd
6.strict bp,pr charting
7.strict i/o charting
8.ryle's tube insertion