A CASE OF CHRONIC PANCREATITIS WITH ANEMIA UNDER EVALUATION

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A 35 year old man, working at a store for printing wedding cards, from Suryapet presented to the casualty at 8pm with the complaints of 

Fever since 2 months

Generalized weakness since 2 months 

Dyspnea on exertion since 2 months 

Pain abdomen since 20 days

Right sided chest pain since 20 days

Vomiting since 20 days 

Dark coloured stools since 20 days

He works at a store that prints wedding cards at Suryapet. He has 2 daughters. Since the past 15 years he has been consuming alcohol everyday, he consumes around 360ml of whiskey per day and his last alcohol intake was yesterday.

Since 15 years he has been smoking, he says he only smokes occasionally. 

Since the past 2 years he started to experience loss of appetite. He also tells us that he started consuming less food and started to consume larger amounts of alcohol. He also tells us that he started to experience recurrent episodes of pain abdomen along with recurrent episodes of vomiting every alternate day and he has visited hospitals 5-6 times over the past 2 years. 

Since the past 2 months he has been experiencing dyspnea on exertion, he says he started to feel dyspneic on walking short distances of less than 100m and also started to experience generalized weakness so much so that he stopped going for work.

He also tells us that over the past 2 months he has been experiencing low grade fever along with loss of around 12kgs.

20 days back he complains of one episode of blood tinged vomitus and has been experiencing increased pain abdomen in his epigastric and right hypochondriac region along with right sided chest pain.

He also complains of black tarry stools since 20 days.

On examination- 

He is a thin built man 

PR - 84bpm, regular

BP - 120/80mmhg

RR - 18cpm

Temp - 98.4 F

Spo2 - 98% on Room Air

Grbs - 102 mg/dl

Pallor +

2 Hypopigmented patches over his abdomen- he has been having them since childhood, pain sensation +

Per Abdomen- 

Diffuse tenderness +

Guarding +

Bowel sounds +

Cvs - 

Palpable P2 +

Apex beat in 6th ICS at MCL

S1,S2 +

ESM +

Lungs - 

BAE +

Clear

Provisional diagnosis-

Chronic pancreatitis with 

Pyrexia of unknown origin 

Anemia under evaluation ( - Secondary to GI blood loss and Nutritional)  

 Heart failure

Hb- 3.8 

TLC - 13,500

Plt - 4.8

Peripheral smear - Anisopoikilocytosis with hypochromasia, microcytes with tear drop cells, pencil cells with target cells and few normocytes

LDH - 363

Retic count - 1.8

Serology negative

LFT - 

Tb - 0.47

Db - 0.18

Ast - 23

Alt - 10

Alp - 161

TP - 5.4

Alb - 2.9

A/G - 1.19

CXR:

TREATMENT:

1)INJ.PAN 40 IV/OD

2)INJ.ZOFER 4 MG IV/TID

3)INJ.TRAMADOL 1 AMP IN 100ML NS IV/BD

4)IVF:2NS,1RL,1DNS @URINE OUTPUT+50 ML/HOUR

5)PLAN FOR PRBC TRANSFUSION

6)INJ.THIAMINE 1 AMP IN 100ML NS IV/TID

7)T.DOLO 650 MG PO/SOS

8) STRICT I/O CHARTING

9) MONITOR VITALS AND INFORM SOS

10)INJ.IRON SUCROSE 1 AMP IN 100 ML NS IV/OD

25/11/21

Amc 1st bed

35M

S

Pain abdomen subsided,fever spike,did n't stools 

O

BP -130/90MM HG

PR- 120BPM

TEMP- AFEBRILE

CVS -S1,S2 HEARD

RS- BAE+

CNS-NAD

PER ABDOMEN-SOFT,NON TENDER

A

?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY

MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P

1.IVF NS,RL 100+50ML/HR

2.INJ.PAN 40MG IV BD

3.INJ.ZOFER 4MG IV SOS

4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS

5.INJ.THIAMINE 1AMP IN 100ML NS IV OD

6.TAB.DOLO 650MG PO SOS

7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD

8.TAB.LORAZEPAM 2MG SOS

9.TAB.PREGABA -M 75MG

26/11/21

35M

S

Pain abdomen subsided,fever spike+,passed stools

O

BP -150/100MM HG

PR- 110BPM

TEMP- 99.8

CVS -S1,S2 HEARD

RS- BAE+

CNS-NAD

PER ABDOMEN-SOFT,NON TENDER

A

?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY

MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P

1.IVF NS,RL 100+50ML/HR

2.INJ.PAN 40MG IV BD

3.INJ.ZOFER 4MG IV SOS

4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS

5.INJ.THIAMINE 1AMP IN 100ML NS IV OD

6.TAB.DOLO 650MG PO SOS

7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD

8.TAB.LORAZEPAM 2MG SOS

9.TAB.PREGABA -M 75MG

27/11/21

Ward patient

35M

S

Pain abdomen subsided,no fever spike,passed stools

O

BP -130/80MM HG

PR- 100BPM

TEMP- 99.8

CVS -S1,S2 HEARD

RS- BAE+

CNS-NAD

PER ABDOMEN-SOFT,NON TENDER

A

?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY

MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P

1.IVF NS,RL 100+50ML/HR

2.INJ.PAN 40MG IV BD

3.INJ.ZOFER 4MG IV SOS

4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS

5.INJ.THIAMINE 1AMP IN 100ML NS IV OD

6.TAB.DOLO 650MG PO SOS

7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD

8.TAB.LORAZEPAM 2MG SOS

9.TAB.PREGABA -M 75MG