45/M c h/o severe pain abd 10 days back relieved on continuos infusion for 2days along c antibiotics+ painkillars. Since 3days back pt. c/ o mild pain abd & heaviness c anorexia. inv / reports ..inclosed . pt is on infusion since 3days c orally nil. Anorexis persist. plz suggest next steps.

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Is it acute pancreatitis? Raised amylase and lipase, with anorexia and pain in your abdomen suggest acute pancreatitis However, level of rise in amylase and lipase is not very high, therefore there is a doubt, Hence differential such as renal failure, GI tuberculosis need to be considered CT abdomen will help clinch diagnosis What is the cause of acute pancreatitis? No gall stone on USG.. Is he alcoholic? Does he have hypercalcaemia or hypertriglyceridemia? This will help in establishing cause. Early enteral nutrition is key in treating acute pancreatitis. Nutrition is started as early as 24 to 48 hours. Those who don't tolerate oral they are given nasogastric feed, some times nasojejunal tube is inserted and feeds are given Early oral nutrition decreases sepsis and enhances recovery

Is that pain is typical of pan pancreatic pain...? Because what you explained it looks like it is Pancreatitis... However amylase, lipase and USG is not suggesting so.. Here i would like to re investigate further.. Do CECT abdomen with oral contrast... OGD scopy for persistent pain...

Can i give food orally?
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Acute pancreatitis. Look for local complications like collections portal vein thrombosis by doing cect abdomen

O think better to wait till diagnosis... Do CT and OGD.. Continue IV fluids till then if diagnosis is still unclear...

Looks Acute abdomen under evaluation. Mild to moderately elevated pancreas enzymes seen in acute abdomen of any Abdominal emergency. Evaluation based on clinical setting should lead to definite diagnosis first.

Reports are not going in favour of pancreatitis too strongly..pt might have had episode of pancreatitis 10 days back..is pt having any other complaint like breathlessness, edema feet?kidney function test?is the pt on any other medication?these enzymes can be elevated in bowel obstruction, inflammation of gi tract(including liver and gb), kidney diseases, medications...cect abdomen with oral contrast provided kidney status permits the same..lft and repeat cbc with esr..chest xray pan and left lateral view.

Uncomplicated Pancreatitis ..pain control, adequate hydration, enteral feeding when vomitting subsides..se calcium, se lipids..any drug history?any concomittant illness?

No concomittant illness... Now mild pain & no vomiting after adequate hydration .. Pt . shifted on oral intake ( liquid diet initially) c advice of complete rest for at least 2m + low spicy & fatty diet + drink filtered water. Rx Tab Enzar Hs bd Tab udiliv 300 bd Syr lactulose 10ml bd Tab pan40 bd
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Acute pancreatitis

CECT report & sr amylase & lipase report done today.

Sr amylase ..186 & sr lipase 190
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Keep the pt NPO.....continue with analgesics and IVF.....CECT Abdomen is a must

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