40 year old male with fever under evaluation chronic pancreatitis and hemorrhoids

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DR. JAYANTH ( INTERN) 

DR. AMULYA ( INTERN) 

DR. SURYA PRADEEP ( INTERN) 

DR. ASHA KIRAN ( INTERN)

DR. YAMINI ( INTERN) 

DR. VAMSHI ( INTERN)

DR. ISMAIL  (INTERN)

DR. PRADEEP ( PG 1st YEAR)

DR. NIKITHA ( PG 2nd YEAR)

DR. SUFIYA ( PG 3rd YEAR) 

DR. SATISH ( PG 3rd YEAR)

Faculty : DR. VIJAYALAXMI 

Here is a case i have seen:

40 years old toddy tree climber came to the OPD with C/O- 

1. Fever since 15days 

2. Vomitings since 15days 

3. Increased frequency of stools on eating meat since 2-3months 

4. Blood in stool since 3months, once/ week.

Patient was apparently asymptomatic 15days back then he developed low grade fever with chills on exertion, associated with pain in b/l wrist, ankle, calf muscles and fingers. Stiffness for 5minutes early in the morning. Dark yellow coloured urine not associated with burning micturition.

No h/o light coloured stools (Increased stool frequency immediately after eating mostly after having protein rich diet).

H/o exposure to rodents in the fields. 

No h/o Rash, pedal edema, decreased urine output.

PAST HISTORY- 

K/c/o ?peptic ulcer disease decreased on medication 4-5 years back.

K/c/o chronic alcoholic since 20years (90-180ml whiskey) 1-2times/month or week intermittently .

K/c/o chronic smoker since 15years 1beedi pack/day stopped 4year back.

K/c/o hemorrhoids since 3months.

Not a k/c/o DM,HTN,TB,CVD, syphilis, asthma.

No history of any previous surgeries 

PERSONAL HISTORY- 

He is a non vegetarian and  his appetite is normal with regular bowel and bladder movements.

No known allergies.

GENERAL EXAMINATION- 

Patient is c/c/c.

Icterus present .

No signs of pallor, cyanosis, lymphadenopathy, clubbing and pedal edema.

No malnutrition and patient looks mildly dehydrated.

Vitals- 

Afebrile 

BP-110/70mmhg 

PR-70/min 

RR-20/min 

SpO2-99% on RA 

SYSTEMIC EXAMINATION- 

CVS-S1 S2 present, no murmurs and no thrills.

RS- BAE present, trachea is central, vesicular breath sounds and no added sounds.

PA- Scaphoid abdomen and tenderness on deep palpation in right hypochondrium, no palpable mass, hernial orifices are normal no free fluid and bruit, liver is palpable and spleen is not palpable.

CNS- Patient is concious with normal speech and there are no signs of meningeal irritation. No deficits in cranial, sensory and motor systems. GCS-15/15.

PROVISIONAL DIAGNOSIS- 

FEVER UNDER EVALUATION SECONDARY TO ?LEPTOSPIROSIS WITH CHRONIC PANCREATITIS WITH HAEMORRHOIDS.

TREATMENT- on day of admission 16/02/2021

1.Inj. CEFTRIAXONE 1gm IV BD.

2.Inj. PANTOP 40mg IV OD.

3.Strict I/O charting.

4.Temperature charting 4th hourly.

5.Monitor vitals.

6.IVF-NS continuous infusion at 50ml/hour.

7.GRBS 6th hourly.

8.T. DOXYCYCLINE 100mg BD.

9.Oral fluids upto 2-3L.

10.Maintain 2-3 episodes of loose stools.

TREATMENT on day 1-17/02/2021 

S- 

Patient is subjectively feeling better.

O- 

Patient is c/c/c.

BP-120/90mmhg 

PR-56bpm 

CVS-S1S2+ 

RS-BAE+ 

CVS-NAD 

PA-Soft 

A-  

FEVER UNDER EVALUATION SECONDARY TO ?LEPTOSPIROSIS WITH CHRONIC PANCREATITIS WITH HAEMORRHOIDS.

P- 

1.Inj. CEFTRIAXONE 1gm IV BD.

2.Inj. PANTOP 40mg IV OD.

3.Strict I/O charting.

4.Temperature charting 4th hourly.

5.Monitor vitals.

6.IVF-NS continuous infusion at 50ml/hour.

7.GRBS 6th hourly.

8.T. DOXYCYCLINE 100mg BD.

9.Oral fluids upto 2-3L.

10.Maintain 2-3 episodes of loose stools.

11. T.UDILIV 300mg BD.

12. Inj.VIT K 10mg IM OD.

TREATMENT on day 2-18/02/2021 

S- 

Patient is subjectively feeling better. No fever spikes, joint pains decreased and stools passed 3times/day appetite increased.

O- 

Patient is c/c/c.

BP-120/70mmhg 

PR-86bpm 

CVS-S1S2+ 

RS-BAE+ 

CVS-NAD 

PA-Soft 

A-  

FEVER WITH JAUNDICE UNDER EVALUATION SECONDARY TO ?LEPTOSPIROSIS WITH CHRONIC PANCREATITIS WITH HAEMORRHOIDS.

P- 

1.Inj. CEFTRIAXONE 1gm IV BD.

2.Inj. PANTOP 40mg IV OD.

3.Strict I/O charting.

4.Temperature charting 4th hourly.

5.Monitor vitals.

6.IVF-NS continuous infusion at 50ml/hour.

7.GRBS 6th hourly.

8.T. DOXYCYCLINE 100mg BD.

9.Oral fluids upto 2-3L.

10.Maintain 2-3 episodes of loose stools.

11. T.UDILIV 300mg BD.

12. Inj.VIT K 10mg IM OD.

TREATMENT on day 3-19/02/2021 

S- Patient is subjectively feeling better. No fever spikes, joint pains decreased and stools passed 3times/day appetite increased.

O- 

Patient is c/c/c.

BP-110/70mmhg 

PR-68bpm 

CVS-S1S2+ 

RS-BAE+ 

CNS-NAD 

PA-Soft 

A-  

FEVER WITH JAUNDICE UNDER EVALUATION SECONDARY TO ?LEPTOSPIROSIS(RESOLVING) WITH CHRONIC PANCREATITIS WITH HAEMORRHOIDS GRADE I.

P- 

1.Inj. CEFTRIAXONE 1gm IV BD.

2.Inj. PANTOP 40mg IV OD.

3.Strict I/O charting.

4.Temperature charting 4th hourly.

5.Monitor vitals.

6.IVF-NS continuous infusion at 50ml/hour.

7.GRBS 6th hourly.

8.T. DOXYCYCLINE 100mg BD.

9.Oral fluids upto 2-3L.

10.Maintain 2-3 episodes of loose stools.

11. T.UDILIV 300mg BD.

12. Inj.VIT K 10mg IM OD.

13. T.ULTRACET 

       1/2----1/2----1/2----1/2 X  2 DAYS.

14. High fibre diet.

15. Avoid non-veg diet.

16. SITz bath.

17. Avoid straining.