FINAL SHORT II

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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