29year old male with c/o abdominal pain and tightness since 10 days
Unit II admission on 02/02/2021
DR. YAMINI ( INTERN)
DR. AMULYA ( INTERN)
DR. SURYA PRADEEP ( INTERN)
DR. ASHA KIRAN ( INTERN)
DR. JAYANTH ( INTERN)
DR. VAMSHI ( INTERN)
DR. ISMAIL (INTERN)
DR. PRADEEP ( PG 1st YEAR)
DR. NIKITHA ( PG 2nd YEAR)
DR. SUFIYA ( PG 3rd YEAR)
DR. SATISH ( PG 3rd YEAR)
Faculty : DR. VIJAYALAXMI
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Here is a case I have seen:
Unit 2 admission on 02/02/2021
29 year old male agricultural worker came with C/O
1. Abdominal pain and tightness since 10days
2. Shortness of breath since 10days
3. Loose stools since 2days
Patient was apparently alright 10days back then he had abdminal pain which was insidious in onset and increased at night.Pain is associated with 2episodes of vomitings, and shortness of breath.
No orthopnea, PND.
Patient went to outside hospital and found to have high Amylase (44 IU/L) and high Lipase (>453IU/L) and was treated as acute pancreatitis for 6days.
From 2days patient is having Loose stools 3episodes/day, watery in consistency, non foul smelling and not associated with blood in stool.
No history of fever, palpitations, chest pain, reduced urine output, pedal edema and burning micturition.
PAST HISTORY: Patient had heart surgery in 2017 (?Congenital heart disease)
Not a k/c/o DM,HTN,Asthma,TB,epilepsy
Patient is alcoholic with regular intake of 180ml/day since 1year (Imperial Blue)
Last alcohol intake 25 days back (90ml)
General examination:
Patient is c/c/c
No pallor, icterus, cyanosis, pedal edema, clubbing, lymphadenopathy
Temperature- 98.4 F
PR- 113 bpm
RR- 30 cpm
BP-130/90mmhg
SpO2- 80% on RA
98% on 2lit O2
GRBS- 124mg%
SYSTEMIC EXAMINATION
CVS: Parasternal thrill Lt>Rt
RS: Grade IV dyspnoea, b/l wheeze
in IMA & ISA, coarse crepts in
B/L ISA
PA: Distended abdomen, no palpable mass or tenderness
CNS: Patient is concious with speech normal, no signs of any meningeal irritation. GCS-15/15
HAEMOGRAM
CUE
PT INR
APTT
CHEST X-RAY
ECG
LFT
RFT
PROVISIONAL DIAGNOSIS:
ACUTE GE with LT LOWER LOBE PNEUMONIA with ? K/C/O CONGENITAL HEART DISEASE k/c/o ACUTE PANCREATITIS ( RESOLVING) with ALD with HYPOALBUMINEMIA
TREATMENT:
1. Inj. THIAMINE 1AMP in 100 ml NS/ IV/ TID
2. Inj. PANTOP 40mg/ IV/OD
3. Inj. ZOFER 4mg/ IV/ SOS
4. IVF NS And RL one unit @ 30ml/ hour
5. NEB. With salbutamol/ ( asthalin) 8th hourly
And BUDECORT 12th hourly
6. Oxygenation to maintain SpO2 >95%
7. Oral fluids upto 2 lit
8. ORS sachets 2 in 1 lit water 200ml after each episode
9. BP/ PR/ Temp/ I/O charting hourly
DAY -1 (03-02-2021)
6.00pm patient had 2 episodes of loose stools
Patient is conscious , coherent
Vitals: temp: afebrile
BP: 130/70mm hg
PR: 103/min
SpO2: 96% with 4lit of O2
82% with out O2
GRBS: 113mg/dl
CVS : S1S2 present
RS: BAE+ ISA left coarse crepts
CNS: HMF intact no focal neurological deficits
P/A : distended, pain in umbilical and flank
area
INVESTIGATIONS:
SERUM AMYLASE:
SERUM LIPASE:
ABG:
PROVISIONAL DIAGNOSIS:
ACUTE GE with ? Lt LL PNEUMONIA with K/C/O ? Congenital heart disease with k/c/o ACUTE NECROTISING PANCREATITIS with CHRONIC PANCREATITIS With ALD with HYPOALBUNEMIA with HFPEF ( EF: 58%)
Rx:
1. Oral fluids upto 2 lit
2. Inj. THIAMINE 1AMP in 100ml NS/ IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with SALBUTAMOL/ ASTHALIN 8th hourly
And BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
8. ORS sachets 2 in 1 lit water 200 ml after each episode
9. Inj. CIPLOX 500mg / IV/ BD
10. Inj. METRONIDAZOLE 100mg/ IV/ TID
11. Inj. LASIx 20mg /IV/ SOS
12. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
DAY-2 (04-02-2021)
Patient complained of 3 episodes of loose stools yesterday
Examination:
Patient is conscious and coherent
BP: 120/70mmhg
PR: 102/ min
No Fever spikes
Temp: 98.5OF
SpO2 : 90% without O2
96% with 4 lit O2
RR: 21/min
GRBS: 95mg/dl
CVS: S1S2 heard
RS: BAE +
CNS: higher mental functions intact
P/A: Distended, pain in the flank area
INVESTIGATIONS:
Serology negative
2D echo:
PROVISIONAL DIAGNOSIS:
ACUTE GE with lt LL PNEUMONIA with ? K/C/O congenital heart disease K/C/O ACUTE PANCREATITIS with ALD
TREATMENT:
1. Oral fluids upto 2 lit
2. Inj. THIAMINE 1AMP in 100ml NS/ IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with SALBUTAMOL/ ASTHALIN 8th hourly
And BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
8. ORS sachets 2 in 1 lit water 200 ml after each episode
9. Inj. CIPLOX 500mg / IV/ BD
10. Inj. METRONIDAZOLE 100mg/ IV/ TID
11. Inj. LASIx 20mg /IV/ SOS
12. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
13. Inj. VIT K 10mg/ IV/ OD
14. 3 eggs/ day
15. T. SPOROLAC - DS/ PO/ BD
CHARTING:
2D ECHO
CT
CECT
DAY- 3 ( 05-02-2021)
S- no new complaints
O- patient is c/c
BP- 140/70 mmhg
PR- 110/min
I/O- 3050/2154
GRBS- 111mg/ dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE +
P/A - Distended
CNS- HMF intact
SpO2- 92% on Ra
96% on 4 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. NPO
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with SALBUTAMOL/ ASTHALIN 8th hourly
And BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
8. ORS sachets 2 in 1 lit water 200 ml after each episode
9. Inj. CIPLOX 500mg / IV/ BD
10. Inj. METRONIDAZOLE 100mg/ IV/ TID
11. Inj. LASIx 20mg /IV/ SOS
12. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
13. Inj. VIT K 10mg/ IV/ OD
14. 3 eggs/ day
15. Tab. SPOROLAC- DS / PO/ BD
16. Abdominal girth measurement daily
17. Tab. Ecospirin - AV 10/74 at 9pm
18. Inj. MAGNEX FORTE 1.5gm/ IV/ BD
19. Cap. RACEDOTIL 100mg/ TID
20. Inj. OCTREOTIDE 100ug/ SC/ TID
21. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
DAY- 4 ( 06/02/2021)
S- pt c/o abdominal tightness and not passing flatus
O- patient is c/c
BP- 150/100 mmhg
PR- 110/min
I/O- 2300/1300
GRBS- 115 mg/ dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE + end inspiratory wheeze in all areas
P/A - Distended diffuse tenderness
CNS- HMF intact
SpO2- 85% on Ra
100% on 6 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. NPO
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
8. Inj. MEROPENUM 1gm/ IV/ BD
9. Inj. METRONIDAZOLE 100mg/ IV/ TID
10. Inj. LASIx 20mg /IV/ SOS
11. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
12. Inj. VIT K 10mg/ IV/ OD
13. Abdominal girth measurement daily
14. Tab. Ecospirin - AV 10/74 at 9pm
15. Cap. RACEDOTIL 100mg/ TID
16. Inj. OCTREOTIDE 100ug/ SC/ TID
17. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
DAY- 5 ( 07/02/2021)
S- pt subjectively feeling better stool and flatus not passed mild diffuse pain in the abdomen
O- patient is c/c
BP- 120/80 mmhg
PR- 98/ min
I/O- 1300/2350ml
GRBS- 123mg/ dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE + wheeze in right axillary infra axillart rt scapular infra scapular areas coarse crepts in rt and lt infrascapular areas
P/A - Distended tenderness on deep palpation more in lt and rt iliac fossa and Peru umbilical area
CNS- HMF intact
SpO2- 92% on Ra
96% on 4 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. Allow sips of clear fluid not exceeding 50ml
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
8. Inj. MEROPENUM 1gm/ IV/ BD
9. Inj. METRONIDAZOLE 100mg/ IV/ TID
10. Inj. LASIx 20mg /IV/ SOS
11. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
12.Abdominal girth measurement daily
13. Tab. Ecospirin - AV 10/74 at 9pm
14. Inj. OCTREOTIDE 100ug/ SC/ TID
15. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
DAY- 6 ( 08/02/2021)
S- pt c/o low back pain stool and flatus not passed
O- patient is c/c
BP- 120/80 mmhg
PR- 98/ min
I/O- 1300/2350ml
GRBS- 143 mg / dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE + wheeze in right axillary infra axillart rt scapular infra scapular areas coarse crepts in rt and lt infrascapular areas
P/A - Distended tenderness on deep palpation more in lt and rt iliac fossa and Peru umbilical area
CNS- HMF intact
SpO2- 92% on Ra
96% on 4 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. Allow sips of clear fluid not exceeding 100ml
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
7. Oxygenation to mainataon SpO2 > 95%
8. Inj. MEROPENUM 1gm/ IV/ BD
9. Inj. METRONIDAZOLE 100mg/ IV/ TID
10. Inj. LASIx 20mg /IV/ SOS
11. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
12.Abdominal girth measurement daily
13. Tab. Ecospirin - AV 10/74 at 9pm
14. Inj. OCTREOTIDE 100ug/ SC/ TID
15. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
17. Incentive spirometry
18. Mobilise the patient frequently
S- pt passing flatus intermittently
C/o low back ache b/L
O- patient is c/c
BP- 120/80 mmhg
PR- 98/ min
I/O- 1300/2350ml
GRBS- 123mg/ dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE + wheeze in right axillary infra axillart rt scapular infra scapular areas coarse crepts in rt and lt infrascapular areas
P/A - distended BS; sluggish
CNS- HMF intact
SpO2- 92% on Ra
96% on 4 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. Allow soft diet
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
7. Oxygenation to mainataon SpO2 > 95%
8. Inj. MEROPENUM 1gm/ IV/ BD
9. Inj. METRONIDAZOLE 100mg/ IV/ TID
10. Inj. LASIx 20mg /IV/ SOS
11. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
12.Abdominal girth measurement daily
13. Tab. Ecospirin - AV 10/74 at 9pm
14. Inj. OCTREOTIDE 100ug/ SC/ TID
15. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
17. Incentive spirometry
18. Mobilise the patient frequently
DAY- 8 ( 10/02/2021)
S- pt passed stools today
O- patient is c/c
BP- 120/80 mmhg
PR- 98/ min
I/O- 1300/2350ml
GRBS- 123mg/ dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE + wheeze in right axillary infra axillart rt scapular infra scapular areas coarse crepts in rt and lt infrascapular areas
P/A - Distended tenderness on deep palpation more in lt and rt iliac fossa and Peru umbilical area
CNS- HMF intact
SpO2- 92% on Ra
96% on 4 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. Allow soft diet
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
7. Oxygenation to mainataon SpO2 > 95%
8. Inj. MEROPENUM 1gm/ IV/ BD
9. Inj. LASIx 20mg /IV/ SOS
10. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
11. Abdominal girth measurement daily
12. Tab. Ecospirin - AV 10/74 at 9pm
13. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
15. Tab. Clonazepam 0.25mg/ OD/ H/S
16. Incentive spirometry
17. Mobilise the patient frequently
DAY- 9 (11/02/2021)
S- pt c/o pain in lt hypochondriac region
O- patient is c/c
BP- 120/80 mmhg
PR- 98/ min
I/O- 1300/2350ml
GRBS- 123mg/ dl
CVS - S1S2 heard PSM in tricuspid area
RS- BAE + wheeze in right axillary infra axillart rt scapular infra scapular areas coarse crepts in rt and lt infrascapular areas
P/A - Distended tenderness on deep palpation more in lt and rt iliac fossa and Peru umbilical area
CNS- HMF intact
SpO2- 92% on Ra
96% on 4 lit of O2
A- 1. Acute GE with lt LL pneumonia with K/C/O congenital heart disease
2. Acute necrotising pancreatitis with chronic pancreatitis with ALD with hypoalbuminemia
3. HFPEF ( EF: 58%)
P-
1. Allow soft diet
2. Inj. Thiamine in 100ml NS / IV/ TID
3. Inj. PAN 40mg/ IV/ OD
4. Inj. ZOFER 4mg/ IV/ SOS
5. IVF NS and RL @ 50ml/ hour
6. NEB with BUDECORT 12th hourly
7. Oxygenation to mainataon SpO2 > 95%
7. Oxygenation to mainataon SpO2 > 95%
8. Inj. MEROPENUM 1gm/ IV/ BD
10. Inj. LASIx 20mg /IV/ SOS
11. Inj. TRAMADOL 1 Amp in 100ml NS/ IV/ SOS
12.Abdominal girth measurement daily
13. Tab. Ecospirin - AV 10/74 at 9pm
15. BP/ PR/ Temp/ SpO2 / strict I/O charting 1 hourly
17. Thrombophobe oint for L/A
Review USG
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