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Case history:-
A 55yr old male, daily labourer by occupation came with complaints of:-
Chest pain since 8 months
Generalized weakness and body pains since 8 months.
He was apparently asymptomatic 8months back, then developed chest pain along wih cough associated with sputum with generalized weakness..Then patient went to local government hospital where he was treated symptomatically and later in July he was diagnosed with TB, for which ATT has started.(2 months of intensive phase is completed and now he is on 3rd month of continuation phase)
After using ATT for 1 month , patient developed pins and needle sensation with generalized body pains with increased appetite , for which patient went to local hospital , where his sugar were found to be high with generalized body pains where he was treated conservatively and patient relieved followed by recurrence of same symptoms .
Patient had repeated visits to the hospital , where his sugars are found to be high and USG showed chronic calcific pancreatitis and right renal calculus .
Patient came to Kims for further evaluation.
Past history:-
K/C/O DM since 4 years( 1st yr- OHA
2nd, 3rd, 4th yr- till april : OHA + insulin)
Patient was started on tab.gliclazide 60mg
Tab.esomeprozole 40mg and domperidone 30mg since 10 days
Tab.nurokind- MORE RF
Tab. Clonazepam 0.5mg po/OD :- 3 days
K/C/O TB 8 months back, and used ATT for 6 months
Personal history:-
The patient reported a long history of alcohol abuse, to a point where he was strained both financially and socially. He also had frequent fallouts with his wife. He also reports a 8 month history of altered bowel habits, with varying diarrhea and constipation. As far as he can recall, the stools were occasionally foul smelling and bulky. Since the last few months, his sleep has taken a hit with lancinating pains all over the body and frequently in his feet. He also reports enjoying beedis (1 pack) for 35 years.
The patient also has decreased appetite and a reduction in overall functional mobility for the past few months.
General examination:-
Patient is conscious, coherent and cooperative, well oriented , thin bulit
Pallor - present
No icterus, clubbing, cyanosis , lympahadenopathy and edema
Vitals:-
Bp:- 110/70mmhg
Pr:- 82bpm
Cvs:- s1s2+
Rs:- BAE+
Systemic examination:-
Per abdomen:-
On inspection:- elliptical in shape, umbilicus is central, vertically slit like
A vertical scar is seen above the umbilicus of approximately 5cm ,( operated for ?gastric perforation) no visible pulsations and engorged veins
Palpation:- soft, tenderness present on left hypochondric and left iliac fossa, no guarding and rigidity , no organomegaly.
Percussion:-
Auscultation:- bowel sounds present
RS:-
Inspection:- right side supraclavicular hallowing, decreased chest movements on right side , intercostal retractions are present, no scars , sinuses, engorged veins
Palpation:- decreased movements on right side
Auscultation:- NVBS , and no additional sounds heard
CVS:- S1S2 heard, no murmurs
CNS:- all higher motor functions are normal
Cranial nerves intact
Sensory system normal
Motor system normal
Cerebellar signs normal
No meningeal signs
Investigations:-
In june
In august
In November
diagnosis-:-
Chronic calcific pancreatitis with right renal calculus with uncontrolled sugars
Treatment:-
1) inj.hai sc according to sliding scale
2) Tab. pregabalin 75mg po/od/h/a
3) inj.pan 40mg po/od
Day 1:-
No fresh complaints
O/E:- pt is c/c
Bp:- 110/70 mmhg right arm supine position
Pr:- 84bpm
Cvs:- S1S2 heard
Rs:- bae+
Treatment:-
1)tab. Pregabalin 75mg po/od/h/a
2) tab.pcm 650mg tid
3) tab.benadon 40mg po/od
4) tab.benfomate plus po/ od
5) inj. Insulin
Day 2:-
No fresh complaints
Investigations:-
Treatment:- inj.h.mixtard s/c bd
Tab. Pregabalin 75mg po/od/h/a
Tab.pcm 650mg tid
Tab.benadon 40mg po/ of
Tab.benfomate plus po/od
Day 3:-
C/o:- right side chest pain which is pricking type after intake of food
Investigations:-
Treatment:-
Inj.h.mixtard insulin 30/70 s/c bd
Inj.h.actrapid insulin s/c od
Tab.pregabalin 75mg po/od/hs
Tab.pcm 600 mg tid
Tab.benfomate plus po/of
Continue att
Inj. Pan 40mg/iv/od
