Case Presentaion Dr Widad

DR.Widad Al-Shukaili

Admitted in Rustaq hospital for 1 day with Dx of pancreatitis ,amylase >2000 ,, discharge LAMA

58 yrs , F , 1 day h/o abdo. Pain and loose motion

At 01:00 AM

A patent

B Spo2 96 %

C HR 105,,BP 84/46

D GCS 15,reflo. 1.5

E 38C,dehydrated

KCO DM on insulin,HTN,IHD with EF 30 % , AF ( aspirin , digoxin , frusimide , simva. ,cavidelol)

6 D h/o constipation ,, followed by 1 D of diarrhea (?? Bloody ?? Mucus) after orange juice

1 D of colicky abdo. Pain mainly upper abdo. radiating to the back ,relieved by leaning forward

5 times vomiting (food particle) ,no heamatemesisAbdo. Distention --- difficulty in breathing

No h/o fever, no previous episode, no similar FHNo genitourinary symptomsNo chest complains or neuro.

Dehydrated , not jaundice , not pale, JVP not raised , no pedal edema , no clubbing

Chest ----- b/l equal air entry , no added sound

CVS------ s1s2

PA distended , gen. tenderness mainly upper abdo. , BS sluggish , hyperesonance

PR no melena

CNS intact

CBC HB 15,WBC 8.9,PLT 332

U/E ur. 17 , cr 200 ,K+ 4.8 , Na 143

LFT AST 899

LDH 583

Lipid profile WNL

Coag. WNL

Lactate 2.6

ABG heamolysed

Amylase 2000 ( high)

Chest XRAY ----- normal

CT abdomen ---verbal report : plain CT done as the pt with RF ,,,, acute pancreatitis with ascitis

58 yrs lady , KCO HTN,DM,AF,IHD on x6 D h/o constipation followed by 1 D diarrhea,rt lumber pain after orange juiceNo feverLAMA from Rust. Hosp. ,,,, amylase > 2000O/e : dehydrated , hypotensive,hypoglycemic ,distended abdo.Inx : amylase 2000 , AST 899 , LDH 583 , lactate 2.6 with derange UECT ------ acute pancrititis with ascitis

Pt admitted under medical word at 6 AM ------ Acute pancreatitis

Pt continue to be hypotensive and febrile

At 9 AM senior radiologist seen CT abdomen ??????

From 9 AM to 11 AM surgeon awaited final CT report

At 11 AM the CT report finalized

At 12 AM surgeon review the pt and decided to operate on her but family refused

At 1 :30 pt arrested ---------------- cleared dead

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