35yr old male presented with chief complaints of pain in epigastric region

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37 yr Old Male Auto Driver By Occupation Came to Casualty with C/o Pain In the Epigastric Region since 1 AM ( 16/03/22 ) 

HOPI :-

Patient Was Apparently Asymptomatic Till yesterday Night Then He Noticed Pain In The Epigastric Region At 1 AM after Passing Stools After Waking Up From The Bed ( After Decreased Alcohol Sedation Consumed Last Night , 180 Ml Whisky ). Then The Pain Was Gradually Increased to Severity in The Morning 6 AM , Squeezing Type Radiating To the Back , Associated With Vomitings ( 3 Episodes in A Day ) food Particles As Content , Non Bilious , Non Projectile . 

Pain Aggravated While Sitting , and Decreased on Sleeping in Right Lateral Position 

Patient Also Noticed Pain in the Left hypochondrium and Thought To be Heart Problem and Approached Nearest Cardiologist In Nalgonda . Cardiologist Said , There is No Problem Related to the Heart and Advised Admission In Some Other Hospital For The Pain The Patient Was Complaining . 

The Patient Came To our hospital for Further evaluation and Treatment .

PAST HISTORY :-

Known case of Hypertension Since 3 months ( Diagnosed In the Government Hospital And Advised To Take Medication , Pateient used Medication for A Week and Then Stopped .)

No Similar complaints In the past .

No H/o DM, TB , Epilepsy , Asthma.

TREATMENT HISTORY :

4years Back the Patient Said to taken Treatment For Urinary tract infection in our hospital and Symptoms Were Releived.

ADDICTIONS :- 

1) Alcohol - Consuming Whiskey Daily Evening Quantity 180 ML , Since 15 years.

2) Cigarette - Smokes 4-5 Ciggerates / Day Since 10 years.

3) Gutka - consumes 10-15 Packs / day Since 10 years.

GENERAL EXAMINATION :-

NO Pallor , Icterus , Cyanosis , Clubbing ,lymphadenopathy.

Vitals 

Temp - afebrile

BP - 160/100 mm hg 

PR - 89 bpm. 

RR - 19 cpm 

spo2 100 @RA 

GRBS - 158 mg/dl @ 8 am

CVS - S1, S2 heard 

RS. :- bae present 

P/A: soft , tender , Guarding Present

CNS :- NAD

INVESTIGATIONS

Serum Lipase - 94

Serum Amylase - 268

HAEMOGRAM

Haemoglobin - 19.7

Total Count - 10,700

RBC -  

Platelet Count - 2.35

RFT

S Urea - 12

S Creatinine - 0.9

S Calcium - 9.9

Na - 140

K - 3.7

Cl - 98

LFT

Total Bilirubin - 

Direct Bilirubin - 0.98

Ast - 45

Alt - 34

Alk P - 165

Total Protein - 8.1

Albumin - 4.1

A/G - 1.03

CRP - Positive 2.4 mg/dl

HbA1c - 7.0 %

Serology - Negative

ECG

USG abdomen 

CECT Report

PROVISONAL DIAGNOSIS

Acute Pancreatitis

Treatment 

1. Nbm till further orders.

2. IVF- NS & RL @ 100ml/hr.

3. Inj. Pantop 40mg/IV/OD.

4. Inj. Zofer 4mg/IV/SOS.

5. Inj. Tramadol 1amp in 100 ml/NS/IV/BD.

6. Inj. THIAMINE 2amp in 1 NS/IV/TID.

7. Monitor vitals.

8. Measure abdominal girth.