Exam

Past history : k/c/o DM since 10years and on Medication ( given by Government ) K/C/O HTN since 7 years and on medication.  Personal history :  PERSONAL HISTORY: Mixed diet, Appetite normal,   alcoholic(30ml/day) and Smoking 36beedis per day.  No  other addictions. GENERAL EXAMINATION: Patient was consious, coherent, cooperative;oriented to time,place,person. Pallor present  No icterus, clubbing, cynosis, lypmhadenopathy. Bilateral pedal edema present.  Investigations: Treatment: 1) Inj. Lasix 40mg /IV /BD.  2)Tab.clinidipine 10 mg /PO/ OD.  3) inj. Human actrapid insulin /SC.  4) tab. Nodosis 500mg PO/TID . 5) Tab. Shelcal CT 500mg/OD 6) Tab. Alfa D3/ PO/OD. 7) Tab. Orofer XT PO/OD. 8) Inj Ceftriaxone 1gm IV/BD. 9) Inj.Erythropoietin 4000IU /SC,weekly twice. 10) Tab.Alpha D3 PO/OD. 11) Inj.Pan 40

Question 1) pain in the epigastric region differentials Inferior wall MI(normal ecg and echo) Acute pancreatitis(radiation to the back)-usg finding and elevated serum amylase level Perforated peptic ulcer  Causes of acute pancreatitis- harrison pg no 2348 Gall stones : https://gi.org/topics/gallstone-pancreatitis/ This occurs at the level of the sphincter of Oddi, a round muscle located at the opening of the bile duct into the small intestine. If a stone from the gallbladder should travel down the common bile duct and get stuck at the sphincter, it blocks outflow of all material from the liver and pancreas. This results in inflammation of the pancreas that can be quite severe. 2)sob- acidosis due to renal failure          ? Ards secondary to sepsis/pancreatitis           Pleural effusion due to acute pancreatitis            3)decreased urine output-pre renal Aki secondary to volume loss(oliguric) 3rd space loss due to pancreatitis Sepsis induced aki 4) abdominal distention with constip