58/M chronic smoker and alcoholism present with severe excruciating pain in epigastrium extending both hypochondria since 2-3 days. No fever, SoB, Vomiting, gi bleed, altered bowel or bladder. Tolerating orally. CBP, ECG, amylase lipase.....WNL. This is Abdomen x-ray erect position. possibilities?

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Possibilities are... Small Perforation Acid peptic disease Intestinal obstruction Chronic pancreatitis

Chronic pancreatitis

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CECT Abdomen revealed bulky head of pancreas with areas of nonenhancement suggestive of necrosis along with collection in lesser sac both paracolic gutters and pelvis. Repeat pancreatic enzymes today has High levels close to 700-800 both amylase and lipase. Sr Ca 8. Responding to conservative approach in HDU. Should be related to alcohol. Thank you all for helping.

Acute pancreatitis--colon cut-off sign.

In this case s.lypase,s.amylase is not positive so less posibility of pancreatitis .posibility of peptic perforation is likely.

Acute panceatitis due to Colon Cut Off sign.

Fluid levels seen in large intestine auscultation usg abdomen or CT abdomen then decide looks perforation dd megacolon

Chronic pancreatitis Int. Obstruction Acid peptic disease

Acute pancreatitis

Acute gastritis, use pentoperazol, stope Alcohol, bland food ,cold milk, manage symptomatically.

Repeat amylase lipase Acute on chronic pancreatitis

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