Concluded Case

PANCREATITIS HEPATOMEGALY Č HEPATITIS CHOLEITHIASIS, PELVIC EFFUSION

A MULTIPLE CASES A 62 years male patient, complaining with pain abdo, pain at hypochondriac region also in umbilical region, nausea č vomiting, loss of appetite, jaundice, lower limb swelling with weakness. Chief Complaints Severe pain abdo, nausea č vomiting, haematuria, chest pain, pain at sternal region, anematic. Pleural effusion. History Alcoholic Vitals BP 150/90mmHg Pulse 110bpm R/R 20bpm Spo2 90% CVS s1 & s2 P Physical Examination Chest B/L ronchi Abdo. distended UL NAD LL AF Edema +++++ DM° Investigations Reports are submitted Management Conservatives management started according to the complications.

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Cholestatic jaundice with pancreatitis Bilateral pleural effusion and Ascitis in peritoneal cavity Limbs are oedematous due to fluid retention Pt is alcoholic has hepatomegaly ALD Sp02 90% All findings indicate pt is in hepatic failure with portal hypertension Mx if ascitis is huge should be tapped and relieve dysponea Niv 02 support Iv inj Ceftriaxozone Inj dexamethasone Inj ondestron Inj pantaprazole Inj lasix Inj glucose 5% Inj RL Let pt to settled down and comeout of failure Shift or add oral medication

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Cholestatic jaundice with pancreatitis Bilateral pleural effusion and Ascitis in peritoneal cavity Limbs are oedematous due to fluid retention Pt is alcoholic has hepatomegaly ALD Sp02 90% All findings indicate pt is in hepatic failure with portal hypertension Mx if ascitis is huge should be tapped and relieve dysponea Niv 02 support Iv inj Ceftriaxozone Inj dexamethasone Inj ondestron Inj pantaprazole Inj lasix Inj glucose 5% Inj RL Let pt to settled down and comeout of failure Shift or add oral medication

Panlipase Udiliv also given
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A case of Acute severe Pancreatitis secondary to cholelithiasis with Alcoholic liver disease , hepatitis which has aggravated Pancreatitis with secondary complications of Pancreatitis ( Pleural effusion, haematuria and Pancreatic peritonitis. Treatment- 1.NPO 2.RT suction 3IV fluids,with correction of electrolytes 4.Parenteral antibiotics- 3rd generation cephalosporins 5.Inj Pantoprazole IV 6.Maintain - input output with urine output monitoring after indwelling catheterization 7.Therapeutic peritoneal lavage may be considered- if peritonism aggravates,

There are multiple pathological features in USG report. To me cholecystitis or gall bladder stones is the main cause of all signs and symptoms added by chronic alcoholism. Due to gall bladder infection there is spreading of infection to the adjuscent organs like pancreas and liver . The jaundice present may be due to slipping of gall stone and causing obstruction of bile flow or obstructing the main pancreatic duct but this is not evident in report then may be due to infection causing oedema of the pancreatic duct causing obstruction of the pancreatic secretion and increase pressure within pancreas and leading to pancreatitis and thus causing oedema of intra hepatic channel causing obstruction of biles causing cholestatic jaundice. Ascitis may be due to alcoholic hepatitis causing or liver changes leading to high venous pressure ( portal hypertension ) causing oozing of liver secretion or may be due to reactionary to infection pancreatitis and cholecystitis. NPm Rules tube suction IV drip for nition Antibiotic higher group of antibiotic Inj metrogyl 100 mg bd Inj PPI Intake output chart

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Acute pancreatitis with ? Obstructive jaundice...? infective hepatitis.. Tab udiliv 300 mg bd*15 days Tab essential L TDs*15 days Tab liveril forte bd*15days Tab panlipase TDs Hepamarz sachet TDs Inj Monocef 1gm bd Tab pan,emeset ,PSM 1 GM SOS ,tab drotin Ds SOS Ors TDs, RL,ns IV fluids.. Inj metro 100 cc TDs Syp Duphalac 15 mg night time Soft diet. Rest Blood test repeat 3days CT abd SOS(p+c) General surgeon opinion.. SOS, Hav,acv,abv,hev

Continue conservative management. May be surgical intervention later on.

Thank you respected dr.
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Alcoholic liver disease with portal hypertension Tap ascitic fluid and send for analysis NIL PER ORAL TILL BOWEL SOUNDS ARE HEARD Nasal O2 Inj Xone Inj Pan 40 Inj lasix 40-20-20 T. UDCA

Thank you doctor
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Pure case of peritonitis Cholecystitis Pancreatitis Opinion of gastroenterologist

COPD Abdominal distension Pulmonary edema

ADVISABLE CONSERVATIVE MANAGEMENT AND PERIODIC. REVIEW SURGICAL. TREATMENT..... IF. SO. REQUIRED ...AFTER. REVIEW

Thank you so much respected dr.
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