Wednesday, September 8, 2010

Case 1 - Acute Pancreatitis

48 years old/Malay/Male/P9G9

No known Medical Illness, Admission from A&E department

C/O - epigastric pain radiated to the back for 2/7
- very severe pain, patient roll on the floor d/t abdominal pain
- worsening today
- no other complaint

PE - vital sign (hypotension, normocardia, LG fever)
- Alert, conscious, in pain, increasing sweating
- Chest examination and CNS examination - NAD

Per Abdomen examination

RHC and epigastric tenderness with guarding (the only physical findings)
no organomegally

Differential Diagnosis
Acute Pancreatitis
Perforated Peptic Ulcer
Acute Myocardial infarction
Acute cholecystitis

Investigations (yang penting dan related)
FBC, VBG, CXR, blood glucose, ECG all normal
Sr amylase - 1372 iu/L

Presentation to dr was done on the day of patient's admission
Questions that dr asked were;

1. State your differential diagnosis (stated above - all accepted)
2. What are the investigations? (as stated above - all accepted)
3. What is your provisional diagnosis, why? (acute pancreatitis - diagnostic criterias includes
abdominal pain radiated to the back, increase sr amylase >3 times normal (53-123) or CT scan showing signs of acute pancreatitis)

Homework given

- What would you expect in this patient CT scan
- Anatomy of pancreas and blood supply (sup pancreaticoduodenal, inf pancreaticoduodenal and splenic arteries)

- Define acute pancreatitis, chronic pancreatits and acute on chronic pancreatitis
- Aetilogy of Acute Pancreatitis (I GET SMASHED - mneumonic)
- How ethanol cause acute pancreatits (state the hypothesis)

- Pathogenesis of Acute Pancreatitis (how gall stone cause pancreatitis)

- Parameters of Ranson's Scoring (mortality rate based on the scores)
- Management in this patient (this patient already Nil by Mouth, on Analgesic and strict IO chart)

Reliable information
2. Bailey and Love, Short Practice of Surgery

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