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
1. http://en.wikipedia.org/wiki/Pancreatitis
2. Bailey and Love, Short Practice of Surgery

1 comment:

Anonymous said...

Hi,
Took Onglyza off and on for a year. I  have an enlarged adrenal gland. Still I await the outcome of that CT, but I know that much. Will find out more.
I had the CT because of chronic pancreatic pain that started out as "attacks" from a couple of times a month to finally after 3 months of use without interruption, "attacks" 2-3 times a week. My PA put Onglyza on my allergies list.
In the meantime, I lost almost 50 lbs in 5 months due to illness. Loss of appetite, pancreatic pain, chronic diarrhea, then eventually, inability to move my bowels. Severe back pain from the pancreas, and severe chest pain sent me to the ER where I was worked up for cardiac pain. I was cardiac cleared, but told my amylase was very low.
Still seeking a diagnosis, but I lay the blame squarely on Onglyza. I'd had pancreatic issues in the past, and argued with the PA that prescribed it, she was calling me non-compliant, and I feared repercussion from my insurance company.
I even took an article about the dangers of Onglyza, particularly in patients with a history, and she made me feel foolish.
I wish I had listened to my instincts, I fear not only damage to my pancreas that is irreversible, but also severe damage to my left kidney, though I have bilateral kidney pain.
I was off all diabetes meds, and control sugars strictly low to no carb. I can barely eat anymore, I have severe anorexia.
I would warn anyone taking Onglyza to consider a change and try Dr Itua Herbal Medicine, and anyone considering taking it, to select a different avenue. I have been suffering severely for about 9 months, but the past 7 months have been good with the help of Dr Itua herbal medicine which I took for 4 weeks.
I have been off Onglyza now, for 7 months, and simply 100% improvement with the help of Dr Itua. I had none of these issues except a history of pancreatitis in my distant past.
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