A 36 years old male came with pain abdomen since 4 days

11/12/2023

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Sanidha Singh 

Roll no.- 98

Unit 4

CHIEF COMPLAINT:  Pain abdomen since 4 days 

HISTORY OF PRESENTING ILLNESS:  Patient was apparently asymptomatic 4 days ago then he developed epigastric pain since 4 days which is dragging type, insidious in onset, gradually progressive and aggravated with food intake and relieved on bending forward.

No h/o fever, cough, breathlessness.

No h/o chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnoea.

No h/o burning micturition, constipation.

Past History: 

N/K/C/O DM, HTN, Asthma, TB, Epilepsy

No h/o CKD, CLD, CAD, CVA

PERSONAL HISTORY: 

Diet- mixed 

Bowel and bladder- regular

Appetite- normal 

Sleep- adequate 

Addiction- chronic alcoholic (whiskey : 180 ml daily) since 15 years. 

GENERAL PHYSICAL EXAMINATION:

Patient is conscious, coherent,cooperative,well oriented to time,place,person. He is moderately built and nourished.

No signs of pallor, icterus, cyanosis, clubbing, lymphoedenopthy, oedema. 

Vitals:

PR- 84 bpm

RR- 16 cpm

BP-140/90mm hg

GRBS- 254 mg/dl

Temp- 98 F

SYSTEMIC EXAMINATION: 

CNS: NFND

CVS: S1 S2 +, no murmurs 

RS: BAE+

P/A: 

Inspection: Abdomen flat, Umbilicus is central and inverted, Appendicectomy scar present, No sinuses, no engorged veins, no visible gastric peristalsis.

Palpating: Abdomen is soft, non distended, tenderness present in the epigastric region, no guarding, no rigidity. No hepatosplenomegaly.

Percussion: liver dullness not obliterated, resonant note heard. 

Auscultation: bowel sounds present. 

INVESTIGATIONS: 

USG DONE ON 10/12/23 

findings

- Elo few hyperechogenic foci noted in the gall bladder all together measuring 9-10 mm

-Elo 32 X18 mm anechogenic cyst noted with internal septations in upper pole of Right kidney

-Elo few cysts noted in left kidney largest @ 12X 11 mm in upper pole.

-Elo altered echotexture  of pancreas with calcification and MPD dilated measuring 5 mm and pancreatic cyst- chronic pancreatitis.

-Elo of 34x30 mm heteroechoic lesion with septation noted in left lobe of liver with no internal vascularity — hepatic abscess or hepatic cyst.

-Elo of multiple enlarged lymph nodes along pancreatic region largest measuring 5 mm. 

Impression: 

• Allered echo texture  of pancreas with calcifications & dilated MPD and pancreatic cyst - f/s/o chronic pancreatitis
  cholelithialsis
• Hepatic cyst or  Hepatic abscess in left lobe de liver.

- B/L Renal cysts & Raised echogenicity 

- prominent lyphmnodes  in para aortic region

Minimal tree fluid in interbowel  region & perihepatic region

Review USG done on 11/12/23 i/v/o liquefaction of abscess 

E/O  29x30mm and 26X 13mm heteroechoic lesion noted in segment

IV A of the liver with liquefaction of 30-40%

E/O 25 x 21 mm Similar lesion noted in segment IV B of the liver with liquefaction of 40-50%

Impression: liver abscess as described above

CECT SCAN - ABDOMEN & PELVIS done on 12/12/23

IMPRESSION:

Chronic calcific pancreatitis with inflammatory mass in head of pancreas -mass

forming chronic pancreatitis.

Peripancreatic stranding suggests acute inflammation - acute on chronic pancreatitis.

38x32 mm pseudocyst in the lesser sac causing compression of stomach.

Cystic dystrophy of medial wall of 2nd part of duodenum.

Thin fluid collection on the subcapsular aspect of visceral surface of liver.

Few tiny calculi in gall bladders.