GASTROENTEROLOGY(A)

 

A1.

Evolution of symptomology:

·        5 yrs. back patient had pain abdomen & vomiting’s - was taken to a local hospital and treated conservatively.

·        He stopped taking alcohol - advised by the physician and was symptom free for nearly 3 yrs., again started alcohol consumption following which he had recurrent episodes of pain abdomen & vomiting 

·        Last year he had almost 5-6 episodes and got treated by a local RMP.

·        In past 20 days – he consumed increased amount of alcohol (5 bottles of toddy per day) 

·        last alcohol - 1 week back following which he again had pain abdomen & vomiting from 1 week and fever from 4 days.

·        Presently patient complained of pain in umbilical, left hypochondriac, left lumbar and hypogastric region.

·        Pain – throbbing type and radiating to back and associated with nausea and vomiting - 1 episode, which is non bilious, non-projectile and also has food particles and water content since 1 week. pain increased after taking food.

·        Fever was high grade, continuous and associated with chills and rigors.

·        Then patient developed constipation since 4 days and passing flatus. 

·        Patient also complained of burning micturition since 4 days, which is associated with suprapubic pain, increased frequency and urgency.

Anatomical localization: Pancreas

Primary etiology: consumption of alcohol

A2.

 

TREATMENT ALONG WITH RATIONALE:

1) ING. MEROPENAM; TID for 7 days 

* Meropenem (broad spectrum Carbapenem) an antibiotic.

2) ING. METROGYL 500 mg IV TID for 5 days

* inj. Metrogyl has METRONIDAZOLE

( Nitroimidazole drug ) an antibiotic

3) ING. AMIKACIN 500 mg IV BD for 5days

* It is an Aminoglycoside antibiotic 

## Here all three of these (Inj. Meropenem, Inj. Metrogyl, Inj. Amikacin ) are used as antibiotics to control infection and ; to prevent septic complications of acute pancreatitis.

4) TPN ( Total Parenteral Nutrition )

* Method of feeding that by passes gastrointestinal tract

* Fluids are given to vein , it provides most of the nutrients body needs.

* TPN has proteins, carbohydrates, fats, vitamins, minerals.

5) IV NS / RL at the rate 12l ml per hour

* Given for fluid replacement ie., treat dehydration 

6) ING. OCTREOTIDE 100 mg SC , BD

* It is a Somatostatin long acting analogue.

* It is used here to decrease exocrine secretion of pancreas and it also has anti- inflammatory & cytoprotective effects.

7) ING. PANTOP 40 mg IV , OD

* Inj. Pantop has PANTOPRAZOLE ( Proton Pump Inhibitor) used for its anti pancreatic secretory effect.

8) ING. THIAMINE 100 mg in 100 ml NS  IV , TID

* It is B1 supplement. 

* It is given here because; due to long fasting & TPN  usage , body may develop B1 deficiency 

* Wernicke encephalopathy secondary to B1 deficiency may be caused... so a prophylactic B1 supplemention is necessary.

9) ING. TRAMADOL in 100 ml NS  IV , OD

* It is an opioid analgesic, given to relieve pain

* So, USG GUIDED MALECOT DRAIN - PLACED INSIDE AND PSEUDOCYST WAS DRAINED

* TWO OTHER USG GUIDED DRAINS ARE PLACED TO DRAIN THE PERI-PANCREATIC COLLECTIONS

* Oxygen supply for mild hypoxia

* And ICD (Inter Coastal Drain) was placed.

 

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