acute pancreatitis with alcohol dependency


This is a case of 45 yr old male came to general surgery op with a chief complaints of of pain in abdomen ,fever , vomitings since one day 
Patient was apparently asymptomatic one day back after which he started developing pain in abdomen ( colicky type,non radiating,no aggregating or relieving factors 

History of present illness
H/o of vomitings (4 episodes)
Bilious non projectile
H/o fever low grade 
No h/o loose stools
No h/o outside food consumption 
He had similar complaints in 2018 and had hospital admission 

Past history 
Alcohol consumption and have alcohol dependency :
He started consuming alcohol in the form of whisky because of peer pressure 
H/o alcohol consumption (1 beer/ day )
Consumes alcohol from 16 yrs 
Had a break of 2 years of drinking whisky and again started drinking in a occasion from past 8months (4-6units/day )
Tobacco consumption (smoking):
4 yrs back (1 packet /2-3days)

He is having sleep disturbances 
Continued drinking despite knowing harmful consequences

Family history
Nill Insignificant
Personal history:
Diet:mixed
Appetite:lost
Bowel :regular
Bladder: normal
Addictions: alcohol and smoking 
Cage assessment:
A- is positive had anger issues
C- is positive wanted to cut down alcohol 
G- positive felt guilty 
E- negative

General examination: 
A 45 yr old patient ,supine decubitus who is well nourished is conscious,cooperative,comfortably seated /lying on the bed,well oriented to time ,place and person 
There is no pallor ,cyanosis,lympadenopathy, dehydration, icterus, clubbing of fingers,oedema of feet
Vitals:
Temp:98.7°c
Respiratory rate:12 cycles/min
Bp:120/80

Systemic examination:
No hypertrophy in gums and mucosa
Inspection:
Umbilicus shape normal (spherical)
Position - central 
No herniation/ discharge 
No movements with respiration 
Abdomen - fullness and tight abdomen 
Skin over abdomen - normal with no pigmentation
Palpation:
Pain above the level of umbilicus 
Pain can be perceived every region but most prominent in epigastric region 
No engorged veins ,visible pulsations, hernial orifices
Superficial:rigidity present
Deep: no case of ascites and fluid thrush
Spleen : not palpable
Cerebellar signs
Fingernose in coordination - no
Knee heel in coordination - no
Normal gait
Normal breath sounds
No murmurs heard 
Diagnosis: pancreatitis caused by secondary cause of alcoholic dependency 
Serum creatinine:
Blood urea
Lipase:
Amylase:

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