A 33 yr old male patient with acute on chronic pancreatitis and cholelethiasis

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Here is a case i have seen: A 33 year old male who was dry fish shop owner and cab driver by occupation came with c/o pain abdomen in the epigastric and left hypochondric region since 1 month 

Pain was moderate-severe intensity,intermittent and aggravated with food intake,releived with medication

Patient was apparently asymptomatic 3 yrs back then developed pain abdomen (for which appendicectomy done)from then there are 4 episodes of acute pancreatitis ,patient got admitted and discharged from kims

In December patient went to Osmania where he was told he had gallstones and calcifications in the pancreas (there he has  treated conservatively for 4 days ) 

Similar episodes till now (4times ) since 2 and half years 

Past h/o appendicectomy done 3 years back 

He was alcoholic drinks 180 ml/day since 10 years (stopped 1 month ago),smoker since 15 years (30 cigars/day)

General examination 

Patient is conscious coherent cooperative 

No h/o pallor ,icterus,clubbing,cyanosis,lymphanednopathy,edema 

Vitals

Temparature-afebrile

Bp 130/80 

Pulse rate -84bpm

RR - 22cpm

Spo2-98%@room air

Grbs 101 mg/dl

Local examination 

P/A 

Inspection:

Shape of abdomen-normal

Umbilicus central,inverted

No engorged veins, scars, sinuses.

No visible pulsations.

Palpation:

No local rise of temperature.

Tenderness seen in the epigastrium and left hypochondrium.

No guarding.

No rigidity.

No organomegaly.

Auscultation:

Bowel sounds heard.

 
Diagnosis -acute on chronic pancreatitis with cholelithiasis 

Treatment 

IVF -1 RL.       -100ml/hr

         1 DNS

Inj pantop 40 mg iv/bd 

Inj ceftriaxone 1g/iv/bd 

Inj optineuron 1 amp in 100 ml NS /iv /OD 

Inj tramadol 1 amp iv in 100 ml NS /iv /OD

Ramsons score 

WBC -10,400 

Age -33 yr 

Glucose -99mg/dl 

AST - 33 u/L 

LDH -240 

Score -0 

Score <3 (0-3% mortality)