A 30 yr old daily wage worker male came to casualty with history of epigastric pain and vomiting since 2 days.

Chief complaints
A 30 yr old daily wage worker  male came to casualty with history of epigastric pain and vomiting since 2 days.

History of presenting illness
Patient was apparently asymptomatic 2 days ago then developed 
epigastric pain which is not radiating to back aggravating with alcohol,  relieved with medications, 
history of 20 episodes of vomiting which are nonbilious non projectile and food particles as contains. 
No history of fever, burning mituration, shortness of breath
History of alcohol binge 3 days back

Past history
History of 7-8 admissions in the past 5 years last admission was one month back with complaints of pain in abdomen in epigastric region associated with 4-5 episodes of vomiting with food particles mixed with blood and then was diagnosed upper GI bleed secondary to peptic ulcer disease or mallory Weiss tear and patient was advised endoscopy but refused to get it done.

N/k/c/o : DM, HTN, THYROID DISEASE, EPILEPSY, 

PERSONAL HISTORY :

DIET - MIXED
APPETITE -NORMAL ,
BOWEL MOVEMENT - REGULAR , 
BLADDER MOVEMENTS - REGULAR, 
ALCOHOL ADDICTION, LAST BINGE 3 DAYS BACK 60 ML WHISKY

FAMILY HISTORY - 
NAD

ON EXAMINATION -

PATIENT IS CONCIOUS , COHERENT COOPERATIVE
PALLOR - absent
 ICTRUS, - absent
CLUBBING , - absent
CYANOSIS ,- absent
LYMPHADENOPATHY , - absent
EDEMA - absent

VITALS - 

TEMPERATURE - 98.1
PULSE RATE - 80 BPM
BLOOD PRESSURE - 100/70 mm of hg
RESPIRATORY RATE - 16
SPO2 - 99 % 

SYSTEMIC EXAMINATION - 
PER ABDOMEN : NON DISTENDED, SOFT NON-TENDER, NO GAURDING/RIGIDITY
CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : B/L air entry present , NORMAL vesicular breath sounds.
CENTRAL NERVOUS SYSTEM : NAD

Clinical images: 






INVESTIGATIONS

LFT
TB - 3.56
DB - 0.98
AST - 26
ALT - 10
ALP - 127
TP - 6.3
ALB - 3.7

RFT
UREA - 25
CREATININE - 0.9
Uric acid 6.8
NA - 140
K - 4
CL - 98

S.AMYLASE - 32
S.LIPASE - 24

FBS - 90

USG abdomen :
Pancreas bulkey with altered echotexture
No evidence of cholelithiasis
No evidence of ascitis


To plan for :
IV fluids NS/RL AT 75ML/HR
INJ. PAN 40MG IV OD
INJ. TRAMADOL 1AMP IN 100ML NS IV TID
INJ. ZOFER 4MG IV TID
INJ. THIAMINE 1AMP IN 100ML NS IV OD

S
c/o abdominal pain decreased
No episodes of vomitings
No SOB

O
TEMP - 98.4' F
PR - 72
BP - 120/80
RR - 16
SPO2 99 ON RA
CVS - S1, S2 +
RS - BAE +, B/L NVBS
P/A - SOFT, NT
CNS - NAD

HB - 15.3
TLC - 7,600
Plt - 1.5 lac

LFT
TB - 3.56
DB - 0.98
AST - 26
ALT - 10
ALP - 127
TP - 6.3
ALB - 3.7

RFT
UREA - 25
CREATININE - 0.9
Uric acid 6.8
NA - 140
K - 4
CL - 98

S.AMYLASE - 32
S.LIPASE - 24

FBS - 90

BISAP - 0

A - acute ABDOMINAL pain secondary to alcoholic gastritis

P
IV fluids NS/RL AT 75ML/HR
INJ. PAN 40MG IV OD
INJ. TRAMADOL 1AMP IN 100ML NS IV TID
INJ. ZOFER 4MG IV TID
INJ. THIAMINE 1AMP IN 100ML NS IV OD
Upper GI ENDOSCOPY

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