History uploaded by Ankit Sharma, Intern PCMS Medicine Research Lab, Bhopal, Fall 2013
50 year old male from lalitpur uttar pradesh presented in medicine opd with loss of appetite since 6 months, fever on and off since 6 months, weakness since 6 moths (increased since last 10 to 15 days), continuous dry cough since last 8 to 10 days, yellowish discolouration of urine since last 8 to 10 days.
Patient is a known case of chronic pancreatitis, undergone cystogastrostomy with pigtail stent insertion 4 years back.
4 years back, patient had excruciating pain in abdomen, abdomen fullness, swelling in upper abdomen for 2-3 days.He went to hospital in Jhansi from where he was sent to Delhi. He was admitted in hospital and kept nil by mouth for 4-5 days then underwent an endoscopic cyst ogstrostomy for cyst (half of the cyst was removed in first time then 1/4 on second time and 1/4 on third time). stent was placed for 1 month after surgery for flushing.
Personal history- Patient is consuming alcohol since last 15 years ( 1/2 bottle whisky per day). He stopped alcohol 4 years back at the time of surgery but again started after 1-2 years. He stopped alcohol 1 month back from now. Sleep - reduced Apetite - reduced Bladder - sometimes burning micturition during night Bowel - loose motions on and off
Family history - NAD
On examination - Pulse - 90/min BP - 110/70 mmhg R/R - 16/min Temp. - afebrile Jaundice - + Edema - +( in feet)
R/S - b/l chest clear CVS - s1,s2 normal CNS - conscious and oriented P/A - tenderness present in right hypochondrium liver 4 cm below costal margin no splenomegaly
LFT - S.protein - A - 3.5, G - 4.1 S. bilirubin - D - 0.48, ID - 0.62 SGOT - 284.0 SGPT - 80.2 ALP - 305.0
KFT - Blood urea - 16.9 S. creatinine - 0.88
12/8/13 USG - hepatomegaly with fatty liver grade II features of chronic pancreatitis - dilated pancreatic duct cholelithiasis
23/9/13 CECT - concentric wall thickening involving distal part of pylorus, 1st and 2nd part of duodenum with dilated major pancreatic duct and CBD. Subtle fat stranding is seen around head of pancreas with foci of calcification in head of pancreas and mild ascitis moderate hepatomegaly and diffuse fatty changes mild splenomegaly cholelithiasis left side mild pleural effusion with basal consolidation
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