Complaint of patient acute pancreatitis

:Severe epigastric pain radiating to the back

:Nausea
:vomitting
:diarrhea
:loss of apetite
:fever
:chills
:dyspnea
Anamnesis vitae
Mansvetov VG Born in 1956 in Yaroslavl, a working class family. Material
and social conditions in childhood were satisfactory.
I went to school at age 7, learning was easy. He graduated from Grade 8 and
15 years enrolled in SPTU that after 2 years and graduated, having mastered
a specialty driver
mechanic. Upon graduation from 1973 to 1975 he passed military service in
the air defense forces, as the driver. After demobilization, and still works as a
driver in MTE-1
Notes from an illness the flu, sore throat, SARS, measles and mumps. In
1990 he took the conservative treatment of closed fractures ankle in a
surgical Emergency Care Hospital them. NV Solovyov. Tuberculosis, diabetes
and sexually transmitted diseases denies. Hypersensitive to drugs is not marked.
From the words of the patient: consume alcohol in moderation, smokes a pack of
cigarettes a day.

Heredity is not burdened.

anamnesis morbi
A 42-year-old man presents to the emergency department
complaining of severe mid-epigastric abdominal pain that radiates to
the back. The pain improves when the patient leans forwards or
assumes the fetal position and worsens with deep inspiration and
movement. He also complains of nausea, vomiting, anorexia, and
gives a history of heavy alcoholic intake this past week. He is
tachycardic, tachypnoeic, and febrile with hypotension. He is
slightly agitated and confused. He is diaphoretic with decreased
breath sounds over the base of the left lung.

Investigations and diagnosis

Blood Investigations
white blood cell count > 16000 cells/mm3
blood glucose > 10mmol/L (> 200mg/dL)
serum AST > 250 IU/L
serum LDH > 350 IU/L
• Calcium (serum calcium < 2.0mmol/L (< 8.0mg/dL)
• Hematocrit fall > 10%
• Oxygen (hypoxemia PO2 < 60 mmHg)
• BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid
hydration
• Base deficit (negative base excess) > 4 mEq/L
• Sequestration of fluids > 6 L
C-reactive protein >10 mg/dl
1) Complete blood count
Erythrocytes 5.54 h1012 / l
Hemoglobin 15.8
Color index 0.9
Leukocytes 19.9 h109 / l
Neutrophils:
stab 12%
segmented 67%
Lymphocytes 18%
Monocytes 3%
ESR 4 mm / h
2) Urinalysis

The color is light yellow

The reaction of acidic
Share of 1010
Transparency of turbid
Protein 0.033
No sugar
Microscopy of sediment:
Epithelial cells 15-20 in the field of view
Leukocytes 1 - 2 in the field of view

Amylase and lipase

• Elevated serum amylase and lipase levels, in combination with severe
abdominal pain, often trigger the initial diagnosis of acute pancreatitis.
• Serum lipase rises 4 to 8 hours from the onset of symptoms and
normalizes within 7 to 14 days after treatment.
• Serum amylase may be normal (in 10% of cases) for cases of acute or
chronic pancreatitis (depleted acinar cell mass) and
hypertriglyceridemia.
• Reasons for false positive elevated serum amylase include salivary
gland disease (elevated salivary amylase) and macroamylasemia.
• If the lipase level is about 2.5 to 3 times that of amylase, it is an
indication of pancreatitis due to alcohol.

Amylase >123 units/L

Lipase 250 units/L

Summary
• Gallstones and alcohol are the most common causes of acute pancreatitis.
• The management of acute pancreatitis includes meticulous supportive care,
with careful attention to volume status.
• Assessment of severity is an important initial step in the care of all patients
with acute pancreatitis.
• A contrast-enhanced pancreatic CT scan should be considered for patients
with severe acute pancreatitis.
• Endoscopic retrograde cholangiopancreatography should be performed in
patients with gallstone pancreatitis and signs of ongoing biliary obstruction
or cholangitis.
• Nutritional support should be administered to all patients with prolonged
NPO status or severe acute pancreatitis.
• Surgical consultation and percutaneous aspiration of pancreatic necrosis
should be considered for patients with clinical deterioration or multiorgan
system failure.