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.

 

Comments

Post a Comment

Popular posts from this blog

NEUROLOGY(D)

Image
  A1. Occurrence of seizure due to brain stroke: ·          Cells in the brain send electrical signals to one another ·          The electrical signals pass along your nerves to all parts of the body ·          A sudden abnormal burst of electrical activity in the brain can lead to the signals to the nerves being disrupted, causing a seizure ·          This electrical disturbance can happen because of stroke damage in the brain. ·          A seizure can affect vision, smell and taste, loss of consciousness and jerking movements. Mechanism of seizure activity: ·          You’re more likely to have a seizure if you had a haemorrhagic stroke (bleed on the brain). ·          Seizures can also be mor...
Read more

55yr old female with fever and headache

Image
Final exam Short case Name: M.Tejaswini Halltkt:1701006107 A 55yr old female came with chief complaints of: -fever since 4 days -headache since 4 days History of present illness Patient was apparently asymptomatic 4 days back then she developed fever which was insidious in onset, continous type relieved with medication and not associated with chills and rigors. Fever was associated with diffuse headache which was throbbing type present throughout the day and relieved with medication. There was 1 episode of vomiting which non projectile, non bilious, content was food. She also had neck stiffness. There's no history of photophobia, giddiness,seizures. Past history No similar complaints in past Not a known case of DM, HTN, TB, asthma, epilepsy Personal history Diet:mixed Appetite:normal Sleep:adequate Bowel and bladder: regular No addictions No known drug and food allergies Family history Not significant General examination Patient is conscious, coherent, coperative. Moderately built ...
Read more

INFECTIOUS DISEASE HEPATOLOGY(B)

 A1. Most likely cause is Amoebic liver abscess because of the following findings:             - Age of the patient             - Single abscess             - Right lobe involvement A2.  - right hypochondriac and epigastric pain , fever ➡ can be liver, biliary or right lower lobe pneumonia -Invesigations:          -CBP : Leucocytosis          -LFT : Elevated Alkaline phosphatase          -RFT           -Urine analysis           -USG : Single hyperechoic   oval shaped mass in right lobe                               ...
Read more