Acute Pancreatitis

Patient is 67 years old lady with no known medical illness. She presented with epigastric pain for 7 hours prior to admission with similar episode of pain in October.

The pain was at sudden in onset, constant and pricking in nature. The pain radiated to the back with no specific agrravating or relieving factors. The pain score was described as 7/10. It was associated with vomiting for 3 times already and vomitus consisted of food particles with no biles or blood seen. Oral intake was reduced. She denied chest pain or shortness of breath, no history of yellow discoloration, fever or changes in characteristics of urine and stool. No URTI Ssx.

On further questioning, patient admit that she had an episode of epigastric pain and had seek treatment for the pain. She was prescribed with rastritis medication and she admit she has ingested traditional Chinese herbs to relieve the abdominal pain back in October.

Prior to current admission, she came to Klinik kesihatan to seek medical attention and was referred to hospital as pain was not resolved.


There was no history of scorpion sting, insect bite and not preceded with trauma. She denied a
history of traditional Chinese herbs ingestion in October to relieve abdominal pain. She denied any consumption of alcohol and she is not a smoker. There was no history of eating outside and no similar problem in family. Her elder brother succumbed to cancer but she wasnt sure what type of cancer.

Physical examination, I lost the result. Hmpphhh...

Investigation

CXR erect...no cardiomegaly
no air under the diapghragm
ECG : sinus rhytm
no acute ischemic changes

ABG
FBC
amylase
LFT
RP
AST LDH
Ca
alb
coagulation profile
total bil
UFEME


PRovisional diagnosis
acute pancreatitis

DDxes
gastritis
peptic ulcer disease


Management

• Treat the cause/stop the possible insulting agent
• Resuscitate
• Anticipate complication

IMRIE score