36 year old male patient with acute pancreatitis

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A 38 years old male patient presented to the opd with the complain of abdominal pain,vomitings, decreased urine output, constipation since 4 days. 

History of present illness

Patient was apparently asymptomatic 4 days back. Then he developed pain abdomen in the epigastric region . Pain is non radiating. 

He had vomitings along with food particles. They are non projectile. 

He consumed alcohol 4 days back thereby developed abdominal pain. 

Past history

There is no history of diabetes, hypertension, TB, epilepsy

There is no history of any major surgeries. 

Personal history

Patient consumes mixed diet. 

Constipation and decreased urine output.

Sleep is adequate. 

Patient is alcohol since 20years consumes(100-120ml/day). 

No smoking. 

Treatment history

No similar complaints in the past. 

No history of any drug allergy. 

General examination. 

Patient is concisous, coherent and co operative. 

Well oriented to the place, time and person. Well nourished. 

Vomitings

No bilateral pedal edema

No pallor

No clubbing

No cyanosis

No icterus

No generalised lymphedenopathy. 

Vitals

Temperature:afebrile

Pulse rate:90beats/min

B. P:160/140mm hg

Respiratory rate:22cycles/min

SPo2:99%

Systemic examination

Cardiovascular

S1, S2 heard. 

No murmurs

Respiratory

Bilateral airway +

Position of trachea: central

Normal vesicular breath sounds+

No crepts. 

Per abdomen

Shape of abdomen:obese

Tenderness present

Liver and spleen not palpable. 

Central nervous system

Patient is concisous

Speech is normal

Reflexes are normal. 

INVESTIGATIONS

ECG

CT scan

Ultrasound report

HEMOGRAM

Haemoglobin:16gm/dl

Total cells:16, 400cells/cumm

Neutrophils:86%

Lymphocytes:08%

Eosinophils:02%

Monocytes:04%

Basophils:0%

RBC:5.07 millions/cumm

Platelet :1.80 lakhs/cumm

Smear: normocytic normochromic blood picture with neutophlic leucocytosis. 

BLOOD UREA NITROGEN:

15.8mg/dl

URINE EXAMINATION

Colour:pale yellow

Appearance:clear

Reaction:acidic

Sp. Gravity:1.010

Album in:++

Sugar:nil

Bile salts:nil

Bile pigments:nil

Pus cells:4-6

Red blood cells:2-4

Epithelial cells:3-4

PROVISIONAL DIAGNOSIS: Acute necrotising pancreatitis secondary to alcohol consumption.

TREATMENT

Intravenous fluids

Inj PANTOP 40mg/IV/OD

Inj ZOFER 4mg/IV/OD

Inj TRAMODOL in 100ml NS/IV/SOS

syrup lactulose10ml/PO/BD

Inj METROGRYL 100ml/IV/BD

Inj THAIMINE 1 ampule in 1 unit BS/IV/TID

Inj MONOCEF 1gm/IV/BD

What are the causes for pancreatitis? 

Differential diagnosis of epigastric pain? 

How alcohol intake causes pancreatitis?