SHORT CASE 1

 This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through a series of inputs from an available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient-related online learning portfolio and your valuable inputs on the comment box. 




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 



   

Comments

Post a Comment

Popular posts from this blog

SHAILESH PATIL DISSERTATION

 THESIS TOPIC CLINICAL PROFILE AND THERAPEUTIC OUTCOMES IN PATIENTS WITH NON ALCOHOLIC FATTY LIVER DISEASE NAME OF THE STUDENT : DR.SHAILESH SAMBHAJI PATIL ( PG 2020-2023) DEPARTMENT OF GENERAL MEDICINE KAMINENI INSTITUTE OF MEDICAL SCIENCES, NARKETPALLY UNIVERSITY: KALOJI NARAYANA RAO UNIVERSITY OF MEDICAL SCIENCES,TELANGANA. HEAD OF THE DEPARTMENT OF GENERAL MEDICINE : DR RAKESH BISWAS . MBBS , MD GENERAL MEDICINE ( PGIMER, CHANDIGARH ) GUIDE: DR A.PRAVEEN NAIK , MBBS , MD ( GENERAL MEDICINE )    ASSOCIATE PROFESSOR , DEPARTMENT OF GENERAL MEDICINE CO GUIDE : DR NAGESHWAR RAO , MEDICAL GASTRO ENTEROLOGIST BACKGROUND – It was the Roman anatomist Galen who made the liver the principal organ of the human body, arguing that it emerged first of all the organs in the formation of a fetus It Is a tough job for the liver to keep the cleaning function of the body especially with the present-day unhealthy eating and drinking habits of people. Non-alcoholic fatty liver disease (NAFLD) is a br
Read more

BIMONTHLY December

Image
 QUESTION NO 1) 1) pt presented vth unable to move his rt upperlimb followed by recurrent episodes of rt sided focal seziures. risk factors in him are alcoholic, smoker, diabetic,on presentation BP was high(170/100mmhg). According to h/o pt might be having cerebrovascular event follwed by focal seziures. Anatomical location could be ?frontal lobe involvement ( imp for cognitive functions and control of voluntary movements), ? parietal lobe (it processes information about movement) could be? anterior circulation stroke. 2) sub cortical infract - occur in the supplying area of a single, deep perforating brain artery and are mostly felt to be a consequence of cerebral small-vessel disease (CSVD). Cortical brain infarcts - infarcts involving cortical gray matter, but may differ considerably in size. ... Small cortical infarcts were mainly localized in external watershed areas, whereas large cortical infarcts were localized primarily in large arterial territories.  3) Cerebrovascular disea
Read more

40/M with chest pain and anxiety

Image
 40 year male from a neighbouring state arrived to our hospital today morning with complaints of retro-sternal chest pain and anxiety since 4 days. Pain was non radiating, crushing type which did not decrease on medication, aggravated on mild activity and was relieved with rest, not associated with palpitations or dyspnea. He had a history of fall ( miscalculated dive in a river and hit a stone) trauma to left temporal area 2 years back after which he had a dull headache in that region radiating to occipital lobe . CT scan was advised which showed extradural hemorrhage along right lobar temporal convexity, for which he came to Kamineni hospitals and was treated with T.PARACETAMOL and T.TEGRETOL for 3 months. His complaints subsided and he went back to his home.  After a lot of slow going passive questions, patient got homey and answered few personal questions. He stated there was nothing wrong with his sleep,appetite,bowel/bladder and daily routine. But then like most of the middle c
Read more