SHORT CASE 1

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Consent and de-identification: The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being conserved entirely. No identifiers shall be revealed throughout this piece of work. 




20 year old female who is a student came to casuality with c/o -


* Pain abdomen since 2 days


* Vomitings since 2 days


* Hypopigmentated lesions over face since 4 months




HISTORY OF PRESENTING ILLNESS


Patient was apparently asymptomatic 2 days back, then she developed pain abdomen in epigastric region, radiating to back, relieved on bending forward, associated with vomitings - non bilious, non projectile ( 4 episodes) subsided on taking medicine.


History of similar complaints in the past, diagnosed with acute pancreatitis, 5 months ago and treated accordingly. No documents available




PAST HISTORY


H/O RTA 3 years back ( fracture to left femur)


where she was diagnosed to have Type 1 DM for which she was on insulin ( subcutaneous, Inj.Mixtard 12 U - X- 10 U) for a year.


Patient observed non compliance to insulin and was shifted to OHA by local hospital.(? Unknown drug)


Patient used OHA for 2 months and stopped in between and started on insulin in her own.


Due to pain abdomen, patient dropped taking insulin for a day




PERSONAL HISTORY


Diet- Mixed


Appetite - Normal


Bowel and Bladder- Regular


Sleep - Decreased due to pain


Addictions - None




General examination:


The patient is conscious, coherent and cooperative, moderately built and nourished, and is well oriented to time, place and person.


BMI- 25.6 Kg/m2 


Pallor: absent


Icterus: absent


Cyanosis: absent


Clubbing: absent


Koilonychia: absent


Pedal edema: absent


Lymphadenopathy: absent


JVP- No rise


Acanthosis nigrans- present over neck

Vitals:


Temperature: afebrile


Respiratory rate: 19cpm


Blood pressure: 120/80 mm Hg


Pulse: 102 bpm


RBS- 480 mg/dl




Systemic examination:




Cardiovascular system:


S1, S2 heard 


No murmurs




Respiratory system:


BAE +


Trachea: central


Vesicular breath sounds heard




Central nervous system:


Patient is conscious 


No focal neurological deficits




P/A 


Soft, tenderness+ in epigastric region, no guarding/ rigidity, bowel sounds heard




PROVISIONAL DIAGNOSIS


Acute pancreatitis with type 1 diabetes 







USG ABDOMEN


*Grade l Fatty liver


*Altered echotexture of pancreas with peripancreatic fat stranding likely acute pancreatitis


*Raised echogenicity

CECT ABDOMEN on 13-4-2023


*Pancreas is slightly bulky with peripancreatic fat stranding and peripancreatic fluid collection in inferior aspect of body of pancreas measuring 5.3 X 3.3 Cm associated with mild thickening of renal fascia bilaterally


*CT Severity index 6/10




Final diagnosis : Acute pancreatitis secondary to hypertriglyceridemia with type 1 DM 



   

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