FINAL SHORT II

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 


INVESTIGATIONS :


ECG


Chest X Ray



                       RFT

                HEMOGRAM

                   CUE

SERUM CREATININE: 0.7MG/DL

HEMOGRAM: 13.0GM/DL

COLOUR:PALE YELLOW

BLOOD UREA:29MG/DL

TLC:11,300CELLS/CUMM

APPERANCE:CLEAR

SERUM SODIUM:137mEq/L

PLT:3.36LAKHS/CUMM


SERUM POTASSIUM:4.5mEq/L


PUS CELLS:3-4/HPF

SERUM CHLORIDE :108mEq/L


EPITHELIAL CELLS: 2-3/HPF



ALBUMIN: NIL 








LFT:

FLP


SERUM LIPASE: 135

TB:1.52

TOTAL CHOLESTEROL:261MG/DL



HbA1C: 6.9%

DB:0.6

TRIGLYCERIDES :932MG/DL


RANDOM BLOOD SUGAR:

382MG/DL

AST/ALT:17/9

HDL:81MG/DL


SERUM AMYLASE: 261

ALP:181

LDL:150MG/DL



ALB:3.32




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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