Case Presentaion Dr Widad

Download Case Presentaion Dr Widad

Post on 02-Jun-2015

390 views

Category:

Documents

5 download

DESCRIPTION

Fen 23rd

TRANSCRIPT

1. DR.Widad Al-Shukaili 2. Admittedin 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 At01:00 AM 3. 4. A patent B Spo2 96 %CHR 105,,BP 84/46 D GCS 15,reflo. 1.5 E 38C,dehydrated 5. 6. 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 heamatemesis Abdo. Distention --- difficulty in breathing No h/o fever, no previous episode, no similar FH No genitourinary symptoms No chest complains or neuro. 7. 8. Dehydrated , not jaundice , not pale, JVP not raised , no pedal edema , no clubbing Chest ----- b/l equal air entry , no added sound CVS------ s1s2 PAdistended , gen. tenderness mainly upper abdo. , BS sluggish , hyperesonancePR no melena CNS intact 9. 10. 11. CBCHB 15,WBC 8.9,PLT 332 U/Eur. 17 , cr 200 ,K+ 4.8 , Na 143 LFT AST 899 LDH 583 Lipid profileWNL Coag. WNLLactate 2.6 ABGheamolysed Amylase 2000( high) 12. Chest XRAY ----- normal CT abdomen---verbal report : plain CT done as the pt with RF ,,,, acute pancreatitis with ascitis 13. 58 yrs lady , KCO HTN,DM,AF,IHD on x 6 D h/o constipation followed by 1 D diarrhea,rt lumber pain after orange juice No fever LAMA from Rust. Hosp. ,,,, amylase > 2000 O/e : dehydrated , hypotensive,hypoglycemic ,distended abdo. Inx : amylase 2000 , AST 899 , LDH 583 , lactate 2.6 with derange UE CT ------ acute pancrititis with ascitis 14. 15. Pt admitted under medical word at 6 AM ------ Acute pancreatitis Pt continue to be hypotensive and febrileAt 9 AM senior radiologist seen CT abdomen ??????From 9 AM to 11 AM surgeon awaited final CTreportAt 11 AM the CT report finalized 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. At 12 AM surgeon review the pt and decided to operate on her but family refused At 1 :30 pt arrested ---------------- cleared dead 46. TAKE HOME MESSAGES