D. THANMAI
ROLL NO. 27
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September 14, 2021
Unit 2 admission
CHIEF COMPLAINTS :
A 65 year old male came to casualty with complaints of vomitings and pain abdomen since one day.
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic one day ago then he ate food that was prepared on previous day , which was followed by vomitings of 10 episodes bilious non projectile, food as content.the last vomitus was Black in color.
He developed Pain abdomen around umbilicus squeezing type radiating to lower abdomen no aggravating or relieving factors.
Shortness of breath - Grade 4
Fever subsided on taking medication
HISTORY OF PAST ILLNESS: Patient had COVID 19 PNEUMONIA 4 months back, No covid vaccine taken.
Patient attender started observing pedal edema and abdominal distension since one month , not associated with chest pain palpitations ,shortness of breath and increased urine output.
No H/O D.M, TB, Epilepsy, Asthma, Hypertension.
PERSONAL HISTORY:
Appetite -
Diet- Mixed
Decreased Bowel movements (constipation)
bladder - Normal
Sleep- Adequate
Addictions- history of alcohol intake since 20 years
60 ml per day
abstinence from alcohol and smoking since 4 months
FAMILY HISTORY : insignificant
DRUG HISTORY: COVID treatment - 4 months back
SURGICAL HISTORY: none
O/E:
Patient was examined in a well lit room, after informed consent.
He was conscious, coherent and cooperative.
No pallor
No icterus
No cyanosis
No clubbing
No koilonychia
No lymphadenopathy
No generalized edema
No pedal edema was observed.
JVP was not seen to be raised.
VITALS: On admission
TEMPERATURE AFEBRILE
Pulse rate: 96 BPM
Respiratory rate: 14 CPM
BP :200/90 mm Hg,
Spo2 98% at Room air.
Grbs 190mg %
SYSTEMIC EXAMINATION
CVS S1 S2 HEARD
RS: BAE +
PA: DISTENDED ABDOMEN , TENDERNESS AROUND UMBILICUS EPIGASTRIC AND RIGHT HYPOCHONDRIAC REGION , BOWEL SOUNDS PRESENT
LAB INVESTIGATIONS:
Day 1
Day 5
Day 6
CHEST X-RAY 14/09/21:
CECT ABDOMEN 18/09/21
USG
2DECHO
ECG
PROVISIONAL DIAGNOSIS:
Acute Necrotising Pancreatitis with Splenic Vein Thrombosis with Mild B/L Pleural Effusion with Denovo detected HTN with Pancreatic ileus ( resolved )
Treatment:
Day 1:
1 IV fluids - NS, RL @ 100ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7. Tab Amlong 5mg po/od
Day 2:
1 IV fluids - NS, RL @ 100ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7. Tab Amlong 5mg po/Od
Day 3:
1 IV fluids - NS, RL @ 100ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7.Inj MEROPENEM 1g /IV/BD
8. Tab Amlong 5mg po/od
Day 4:
1 IV fluids - NS, RL @ 100ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7.Inj MEROPENEM 1g /IV/BD
8. Tab Amlong 5mg po/od
Day 5:
1 IV fluids - NS, RL @ 100ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7.Inj MEROPENEM 1g /IV/BD
8. Tab Amlong 5mg po/od
Day 6
1 IV fluids - NS, RL @ 75ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7.Inj MEROPENEM 1g /IV/BD
8. Tab Amlong 5mg po/od
Day 7:
1 IV fluids - NS, RL @ 75ml/hour
2. Inj Pantop 40mg/IV/OD
3. Inj. CLEXANE 60mg s/c OD
4. Inj TRAMADOL 1amp in 100ml NS/IV/SOS
5. Inj ZOFER 4mg/IV/SOS
6. Syp. CREMAFFIN PLUS 30 ml po/bd
7.Inj MEROPENEM 1g /IV/BD
8. Tab Amlong 5mg po/od
My questions around the case :
1. could COVID 19 have caused pancreatic injury and then followed by post COVID complications like thrombosis lead to Acute pancreatitis?
2. why were anti coagulants stopped?
3. what's the exact cause for this patient's condition?
4. Is partial pancreatectomy the best choice?
