pancreatitis-Acute

Hari ni duty OPD(out patient department),tak banyak admission,cume ade 5 kes baru kene admit..^_^..satu 'kelegaan' utk seketika..hehehe
tapi minggu ni total kes ade 3 CVS,4 GIT,4 Respi dan 2stroke patient..

dan yang menarik perhatian aku 3/4 hari ni ke hospital selain collect reports,tulis doctors orders dll,aku tertarik dengan satu kes ni.
.Acute pancreatitis..

15y old female,10th std student,was apparently well till she presented with abdominal pain since 10 days back and increased in severity about 1 day prior to admission.pain is diffuse,on and off,pricking in nature,radiates to retrosternal region and to the back.h/o 4/5 episodes of vomiting increased on taking food,non projectile,non bilious,non blood stained.h/o fever since 2 days,moderate-high grade +chills.h/o passing loose stools 3/4 episodes prior to admission.no h/o headache,neck stiffness,dyspnea on exertion,chestpain,burning micturition.past history-had similar complaints on 2009(june),USG abd was done,USG-scopy done-Normal.
no h/o addiction.

on examination.patient was febrile,dehydrated and tachycardia +
icterus+.BP 130/90mmHg.P/A-soft,diffuse tenderness +++ in epigastrium,Rt and Lft hypochondrium and lumbar region.organomegaly cannot be appreciated d/t tenderness
other system-NAD.

based on History and examination findings:
i would consider ________ in this patient.
1: Acute pancreatitis - classical triad of intermittent pain,vomiting and fever,
icterus+,tenderness over epigastrium
2.acute gastroenteritis/food posioning-unlikely coz it is usually an acute condition
this case had h/o 10 days abdominal pain ??
3.peptic ulcer - vague history

so lepas send Ix like CBC,Amylase,LFT,urine routine,fasting lipid profile etc
Amylase level - 1200 !! (ok ni memang sangat significant value ) N - <100>
since amylase in not spesific for pancreatitis,Lipase enzyme level was sent - 973! (N:13-60) Lipase - Diagnostic for pancreatitis urine routine-glycosuria+++,protenuria+ - support the diagnosis TC-15,110 -leukocytosis TB,DB- high RBS- normal
since Creat- Normal Ca- Normal - absence of necrotic stage and saponification
so final diagnosis---------> acute pancreatitis
so macam mane nak manage ?-
1.RT aspirates- and withold foods and liquids by mouth
2.IVF DNS 125 ml/h
3.inj Neksium 40mg iv OD (esomeprazole- PPI)
4,Inj Emeset 4mg iv sos - antiemetics
5.inj tramadol 1 amp slow iv q8h- analgesics
6.Inj Recozone A 1.125 mg iv q8h
7.inj ornida 100ml iv BD - antibiotics againts anaerobes

now ni,tgh treat only symptomatically,and patient has improved ,vitals stable..so far,we are still figuring out wats the cause behind acute pancreatitis in this patient..Abd X ray -Normal ,fasting lipid profile-normal ,so hopefully CT scan can be done tmr and we'll see if there is any significant findings..


ok.will update asap..=)