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An interesting case of Acute pancreatitis

An interesting case of Acute pancreatitis. Prof.Dr.M.Muthiah.MD Vii MU. Case summary. Mr.Mariyappan is a 35 year old male,referred to us for localised dull aching left lumbar and left iliac pain and raised renal parameters following a skid from his two wheeler ( 1 week ago).

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An interesting case of Acute pancreatitis

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  1. An interesting case of Acute pancreatitis Prof.Dr.M.Muthiah.MD Vii MU

  2. Case summary Mr.Mariyappan is a 35 year old male,referred to us for localised dull aching left lumbar and left iliac pain and raised renal parameters following a skid from his two wheeler ( 1 week ago). h/o ethanol intake present – 250ml alcohol once a wk for past 8 years no other significant history

  3. Clinical examination • Pt conscious • Oriented • Afebrile • Pallor + • Mild icterus • No signs of fluid over load • Bruises + over face and trunk

  4. vitals • Pulse – 82/min • BP – 150/90mmHg • RR – 16/min • Temp – 98.4oF

  5. Systemic examination • PA – epigastric tenderness + fullness lt flank bimanually palpable tender mass felt in the left lumbar region. ?renal mass • Bowel sounds + • Other systems normal

  6. Investigation • Urine – alb trace sug nil deposits 3-6 pus cells /hpf • Blood sugar – 72mg/dl • urea - 186mg/dl • sr creatinine- 11.2mg/dl

  7. Investigations…… • T bilirubin – 2.0 mg/dl • Direct – 1.0 mg/l • Indirect -1.0mg/dl • AST – 26 IU • ALT – 20 IU • ALP – 297 IU • Total protein – 5.6g/dl • Alb – 3.3g/dl • Glob – 2.3g/dl • Serum amylase – 194iu • Triglyceride – 108mg/dl

  8. Investigations… • ECG - WNL • Hb – 9.6mg% • TC – 9800cells/cumm • P84 L13 E2 M1 - neutrophillia • Plt – 2.1lakhs/cumm • Pcv – 30% • Esr – 50mm/hr • Coagulation profile - normal • Serum ca – 7.5mg/dl • Serum P – 5.5mg/dl

  9. Provisional diagnosis ? Blunt trauma kidney ?Chronic renal failure bilirubin? proceeded with imaging

  10. Chest xray • Raised left Diaphragm Mild pleural effusion

  11. Ultrasound abdomen • Liver – 13.2 cm, normal echoes • Gall bladder – N • Pancreas – Normal • Rt kidney – 9*4.6cm • Lt kidney - 10.6 * 5.32cm • cortical echoes, CMD maintained • Free fluid + • Impression – MRD with Ascites

  12. OGD • Oesophagus – multiple linear erosions in the lower half of oesophagus • stomach – extraneous impression over posterior wall of the stomach • Duodenum – D1 erosions D2 normal

  13. CT abdomen and pelvis Edematous pancreas with pseudocyst measuring 8.5 * 7.5 cm extending from behind the stomach with perisplenic fluid collections,pushing the spleen and perinephric fluid collections retroperitoneally pushing th left kidney anteriorly

  14. Colon cut off

  15. stomach liver pseudocyst Lesser sac Lesser sac

  16. pseudo cyst Fluid spleen

  17. pancreas Lt kid fluid

  18. Course of the disease…. patient was Rx with iv fluids and antibiotics, blood urea and serum creatinine came to normal in 14 days. patient transferred to surgical gastroenterology for further management.

  19. Final diagnosis Acute pancreatitis with pancreatic pseudocyst

  20. Interesting aspects of this common case! Masquerading presentation

  21. A zillion thanks!!!!

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