2nd internal assessment

Paper I






























Paper - II 

36 year old male with epigastric pain

A 36 year old male with epigastric pain

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Case History



a 36 year old male , driver by occupation ,came to the casualty with 


CHEIF COMPLAINTS OF -


complains pain in the epigastric region since 8 days 


HISTORY OF PRESENTING ILLNESS -


patient was apparently asymptomatic 9 days back then he developed  pain in the epigastric region    which was   sudden in onset ,   dragging type of pain and non-radiating type ,   aggravated on sleeping in Lateral position relieved on medication. Tightness of the abdomen since 4 days
 High grade Fever since 9 days which was sudden in onset associated with chills and rigors and headache (frontal and occipital) . He developed shortness of breath since 5days (grade 2 )   constipation since 4 days  and decrease in appetite. 


complains of belching 2 to 3 times per day 

He had similar episode previously in June 2021 with complaint of pain and distended abdomen. 

no history of nausea vomiting , no h/o loose stool ,no history of past surgery 
no history of jaundice previously 
no history of gallstones, 


PAST HISTORY - 

Similar history 6months back , not a known case of htn , dm , epilepsy , asthma , tb
no previous surgical history 
no history of gallstones in the past


PERSONAL HISTORY :


diet - mixed ,

appetite -decrease appetite ,

bowel movement - irregular since 3 days, 

 bladder movements - regular ,

addictions(alcohol and smoking) - 

alcoholic in seven years takes at least 150 ml 
occasional toddy user also since six months drinks 180 ml per day 
 brand used it is (royal stag or ib )180 ml per day is in six months
 
no history of smoking or chewing tobacco



FAMILY HISTORY - 

not significant


GENERAL EXAMINATION -


patient is concious , coherent cooperative
no pallor , icterus Present - mild, clubbing , cyanosis , lymphadenopathy , edema




vitals - 

8-1-22
temperature - afebrile

pulse rate - 97 bpm

blood pressure - 100 /70 mm of hg 

respiratory rate - 22

spo2 - 98% at room air


SYSTEMIC EXAMINATION - 


cardiovascular system : s1 and s2 heard , no murmurs
respiratory system : bilateral air entry present ,normal vesicular breath sounds
central nervous system : nad

p/a -
Abdomen is slightly distended
Umbilicus central , inverted , all quadrants moving appropriately with respiration
No scars , engorged veins, no visible peristalsis or pulsations
pain in the epigastric region and 
pain is more in the right iliac and lumbar region
no bruit’s , no gaurding, no rigidity
negative cullens sign and grey turners sign, no fox's sign
bowel sounds present 




INVESTIGATION - 




Elevated serum amylase and lipase
Stool for occult blood positive


HEMOGRAM: 




CUE:



RFT:





CT scan











COMPLETE URINE EXAMINATION: 











PROVISIONAL DIAGNOSIS -

Acute pancreatitis
With alcohol dependence



TREATMENT GIVEN -


1 . ivf ns and rl and dns @ 50 ml /hr

2. ink . pantop 40 mg iv/od

3 .ink zofer 4 mg iv sos

4. inj tramadol 1 amp in 100 ml na iv bd

5.inj buscopan 22 cc iv/sos

6.tab pcm 650 mg po/tid 

7.grbs 6 th hourly

8 temp and i/o charting



Questions
What is the cause of shortness of breath?
What is the cause for Positive occult blood stool ?