43 year old male with bilateral loin pain and pain abdomen
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Here is a case i have seen:
A 43 year old male presented with C/o vomitings,decreased appetite, b/l loin pain since 12 days
Pt was apparently asymptomatic 12 days back then he c/o decreased appetite since 12 days and vomitings immediately after intake of solids, liquids which was non bilious,non blood stained since 12 days and stopped 4d ys back
C/o burning micturition since 12 days
C/o decreased urine output since 10 days, c/o constipation since 10 days, fever since 4 days(subsided now)
No history of pedal edema, cough,cold,sob,palpitation
Pt had h/o similar complaints in the past ?pancreatitis 7 years back
Pt had h/o usage of NSAIDS for?joint pains since 7 years
8 yrs back h/o skid and fall from bike and sustained trauma to RT knee for which casting was done
Since 7 yrs b/l knee pain started , on and off after 6 months generalized joint pains , non radiating , on and off ( b/l wrist , elbow , shoulder , ankle , small joints of fingers for which he took multiple injections of tramadol , decadron )
There is no h /o morning stiffness , fever
In the past 6 months he didn't took any injections , he was using tablet pcm whenever he has pain .
H/o of swelling present since 7 yrs at b/l metatarsophalangeal joints , elbow , sternoclavicular joint . He developed b/l knee swelling 5 yrs back for which pus was aspirated ( each knee joint 2 times ) and took some antibiotic injections ( no records available )
K/c/o chronic alcoholic since 20 years daily 90ml
Not a smoker
Not a k/c/o DM, HTN, CVA, CAD, epilepsy, asthma
Examination :
O/e pt is c/c/c
Afebrile to touch
PR:80bpm
BP:120/70
Spo2:98
P/A:soft,tenderness present on b/l loin region, rt hypochondrium, hepatospenomegaly present,BS:sluggish
RS:B/LAE+,nvbs
CVS:s1,s2+,no murmurs
CNS:no FND
Investigations at admission
Day 2
C/o B/L loin pain decreasing in intensity
C/o constipation since 19days,not passing flatus
No fever spikes over night
Grbs 191
I/0 1500/1800
Ryles drain 100ml
O/e pt is c/c/c
Afebrile to touch
PR:80bpm
BP:130/90
Spo2:80
P/A:soft,tenderness present on b/l loin region, rt hypochondrium, hepatospenomegaly present,BS:sluggish RS:B/LAE+,nvbs
CVS:s1,s2+,no murmurs , CNS - no FND
Treatment sips of water plus same treatment
Day 3
C/o b/l loin pain decreasing intensity
C/o constipation since 12 days , passing flatus
No fever spikes
Grbs - 181
I/O - 2100/2300
Ryles drain - 500ml
O/e :
Pt is c/c/c
Pr - 78bpm , regular BP -120/80mmhg
CVS - S1 S2 + , RS - BAE + NVBS , CNS - no FND
P/A - tenderness in RT hypochondrium
B/l loin pain . BS sluggish
Treatment
Plenty of oral fluids - 3l/ day , liquid diet
Plus same treatment given
Rules tube removed
Soap water enema at 8pm
Day 4
Passed stools yesterday night
No fever spikes
GRBS - 187
I/O - 2250/2300
O/e :
Pt is c/c/c
PR - 72bpm regular BP - 110/70 mmHg
CVS - S1 S2+ ,. RS - BAE + NVBS , CNS - no FND
P/A - soft, tenderness in RT hypochondrium
BS + sluggish
Diagnosis : Acute pyelonephr itis, Chronic pancreatitis , Pre renal Aki ( resolving ) , soft tissue mass in mesentery ? Malignancy , alcohol dependence syndrome.
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