A 65 year old male with pain abdomen and constipation.
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Serum proteins
Urine protein/creatinine ratio
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A 65 year old male came to casuality with chief complaints of pain abdomen since 3 days,constipation since 2 days.
History of present illness-
Patient was apparently asymptomatic 3 days ago,then he developed pain abdomen and constipation since 2 days.The abdominal pain is diffuse,more in epigastrium and left hypochondrium and is radiating to the back,increased with having food having high fat content.He was a chronic alcoholic since 40 years,last binge was taken 3 days back,No history of vomiting and fever.No other complaints.
History of past illness-
Not a K/C/O dm,htn,asthma, epilepsy,cad,tb
Personal history-
Diet-mixed
Appetite-lost
Bowel-constipation.
Bladder-regular
Addictions-Regular alcoholic 90ml/day since 40 years.
Vitals-
Icterus is present,
There is no pallor,cyanosis, clubbing, lymphadenopathy.
Vitals-temp-afebrile
Pr-94/min
Rr-17/min
Bp-180/100 mm hg
spO2-98% at ra.
Systemic examination-
CVS- S1,S 2 heard
No added sounds.
Respiratory system-BAE +
NVBS heard.
Per Abdomen-
Abdomen is distended,tenderness is diffuse more in epigastrium and left hypochondrium,no palpable masses,liver and spleen not palpable,bowel sounds present
Cns- NFND
Investigations-
Ecg-
Cxr- on 28/8/21
Erect pa-
On 1/9/21,
Blood urea-90
Creatinine-2.7
Haemogram-
Serum electrolytes-
On 2/9/21,
Haemogram-
Cxr- on 2/9/21
2 D echo
Pleural fluid aspiration was done.
Total 650 ml was aspirated and sent for analysis.
Pleural (sugar,protein)
Pleural fluid amylase
Pleural fluid ldh
Serum ldh
Applying lights criteria,
1.pleural fluid protein/serum protein should be greater than 0.5,here it is 0.465(not satisfied)
2.pleural fluid ldh/serum ldh should be greater than 0.6,here it is 0.72(satisfied)
3.pleural ldh should be greater than 2/3 Serum ldh
Here,200 greater than 182.6(satisfied)
Since 2 of 3 conditions of lights criteria are satisfied ,pleural fluid is exudative in nature.
Abg-
Haemogram on 3/9/21
Provisional diagnosis-
Acute pancreatitis secondary to alcohol.
Plan of care-
IV fluids-Ns,RL,DNS @ 150ml/hr continous
Inj.pan 40 mg iv bd
Inj.zofer 4 mg iv sos
Inj.piptaz 2.25 gm iv tid
Inj.tramadol 1 amp in 100 ml NS IV bd
Inj.thiamine 1 amp in 100 ml NS IV tid
Inj.optineuron 1 amp in 100 ml NS IV od
Bp,pr,temp,spO2 monitoring
Psychiatry referral was done and adviced
Tab. Lorazepam 2mg for 2days
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