65 year old male

 Unit 2 admission:

INTRODUCTION:

A 65 year old male came to casualty with complaints of vomitings and pain abdomen since one day.

CHIEF COMPLAINTS:

Patient was apparently asymptomatic one day ago and he had before day food, followed by vomitings of 10 episodes bilious non projectile, food as content. He developed Pain abdomen around umbilicus squeezing type radiating to lower abdomen no aggravating or no relieving factors.

HISTORY OF PAST ILLNESS: COVID 19 PNEUMONIA, 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. 

PERSONAL HISTORY: known case of alcohol since 20 years

O/E:

 VITALS: 

TEMPERATURE AFEBRILE 

Pulse rate: 96 BPM

Respiratory rate: 14 CPM 

BP :200/90 mm Hg, 

Spo2 98% at Room air. 

Grbs 190mg %

CVS S1 S2 HEARD

RS BAE +

PA: DISTENDED ABDOMEN , TENDERNESS AROUND UMBILICUS EPIGASTRIC AND RIGHT HYPOCHONDRIAC REGION , BOWEL SOUNDS PRESENT

LAB INVESTIGATIONS:

HEMOGRAM: Hb 15.4 TLC 15,500 PC 2.18

SERUM LIPASE- 107


SERUM AMYLASE- 397



LFT:

TB: 1.42

DB: 0.35

AST: 36

ALT: 24

ALP: 176

TP: 6.8

ACB: 4.0

A/G: 1.48


RBS: 193

UR: 4.6

CR: 1.3

Na: 143

P: 4.5

Cl: 102


CHEST X-RAY @ 14/09/21:









CECT ABDOMEN@ 18/9/21






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

Day 8:

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 9:

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 10:

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 11:

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










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