A 22 YEAR OLD MALE DIAGNOSED WITH ALCOHOL AND TOBACCO WITHDRAWAL SYNDROME CAME TO DE-ADDICTION AND, PATIENT COMPLAINS OF ABDOMINAL PAIN
June 10,2022
Hi, I am Aziza Ferdose 3rd sem medical student. this is an online elog book to discuss our patients health data after taking his consent. this also reflect my patient centered online learning portfolio.
A 22 year old male painter by occupation resident of nalgonda came to de-addiction because he had alcohol and tobacco withdrawal syndrome then the patient complained of abdominal pain.
HISTORY OF PRESENT ILLNESS:
The patient was apparently asymptomatic 5 years back then started consuming alcohol gradually increase it to 12-18 units in a span of 5 years. since 2 months he consumes 3 units/day.tobacco smoking since 4-5 beedies/day. denies any personal, professional, and financial stress. patient has cravings for alcohol and tobacco tremors sleep disturbance on not taking alcohol.
2 months back admitted in a hospital because of weakness, reduced appetite, abdominal pain, and had hallucinating behaviour then became normal in 2 days.
since 2 months reduced amount of alcohol to 90ml but stomach pain was reoccuring not completely stopped.
3 days back complained of severe abdominal pain sudden in onset in epigastric and left hypochondrium region radiating to back burning in nature intermittent and reduced on lying forward, not associated with fever, vomitings, constipation, loose stools.
no complains of chest pain, sweating, palpitations, burning micturition
PAST HISTORY
no history of head injury, siezures, low moods
no previous history of TB. asthma, or copd
no history of diabetes, hypertension
no history of allergies
PERSONAL HISTORY
Diet : mixed
appetite decreases since 2 months
habits : alcoholic, and smokes
bowel and bladder :finds difficulty in passing stools if doesnt consume tobacco
sleep: sleep disturbance on not taking alcohol
VITALS
patient is concious , coherent, cooperative
pulse : 102/min
blood pressure : 110/70 mm hg
SYSTEMIC EXAMINATION
CVS
s1 and s2 heard
LUNGS BAE +
ABDOMINAL
palpation voluntary guarding tenderness in left hypochondrium
INVESTIGATIONS
HBsAg - Rapid test
Examination of anechoic cystic lesion noted involving the body of pancreas without internal vascularity likely psuedocyst
PROVISIONAL DIAGNOSIS
Acute pancreatitis
pseudocyst of pancreas
TREATMENT
iv fluids ; RL,NS 100ml/hr
inj tramadol 100mg /iv
inj zofer 4mg /iv
inj pan 40 mg/ iv
inj optineuron
tablet lorazepam 2mg
tablet benfotiamine 100mg
nicotine gums 2 mg
QUESTIONS
WHERE IS THE ANATOMICAL POSITION OF THE PATIENTS PROBLEM ?
ANATOMY OF PANCREAS
The pancreas is an oblong-shaped organ positioned at the level of the transpyloric plane (L1). With the exception of the tail of the pancreas, it is a retroperitoneal organ, located deep within the upper abdomen in the epigastrium and left hypochondrium regions.
Within the abdomen, the pancreas has direct anatomical relations to several structures
Organs:
• Stomach, duodenum ,transverse mesocolon, common bile duct , spleen
Vessels
The pancreas lies near several major vessels and significant landmarks in vascular anatomy:
• The aorta and inferior vena cava , superior mesenteric artery, hepatic portal vein .
The pancreas is typically divided into five parts:
• Head, uncinate process , neck , body , tail
Vasculature
pancreatic branches of the splenic artery.
superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries,
Venous drainage
superior mesenteric branches of the hepatic portal vein
Lymphatics
pancreaticosplenal nodes and the pyloric nodes, which in turn drain into the superior mesenteric and coeliac lymph nodes.
WHY IS THE PATIENT HAVING THIS PROBLEM ?
Patient is diagnosed with alcohol and tobacco withdrawal dyndrome and acute pancreatitis with psuedocyst.
Main cause : Alcohol and tobacco smoking
Alcohol use syndrome is one of the most common causes of both acute pancreatitis.
Acute pancreatitis (AP) is a necro-inflammatory disease resulting from exocrine cell destruction by infiltrating inflammatory cells
Alcohol consumption causes acute pancreatitis and is the second most common cause of AP after gallstones. It usually manifests in patients with over five years of ongoing, substantial alcohol use (~4-5 drinks daily)
Cigarette smoking might have an additive effect with alcohol in inducing pancreatitis
• Pancreatic pseudocyst, seen as a walled-off fluid collection, usually arising >4 weeks from symptom onset.
Symptoms
• Acute abdominal pain. Typically epigastric that radiates to the back.
• Of note, pain may be less abrupt and poorly localized in alcoholic pancreatitis.
• Nausea or vomiting
PATHOGENESIS
Alcohol and its metabolites produce changes in the acinar cells, which may promote premature intracellular digestive enzyme activation thereby predisposing the gland to autodigestive injury. Pancreatic stellate cells (PSCs) are activated directly by alcohol and its metabolites and also by cytokines and growth factors released during alcohol-induced pancreatic necroinflammation. Activated PSCs are the key cells responsible for producing the fibrosis of alcoholic chronic pancreatitis
Alcohol use syndrome is one of the most common cause of acute pancreatitis.
WHAT ARE WE DOING ABOUT IT ?
PHARMACOLOGICAL INTERVENTIONS
iv fluids ; RL,NS 100ml/hr
inj tramadol 100mg /iv
inj zofer 4mg /iv
inj pan 40 mg/ iv
inj optineuron
tablet lorazepam 2mg
tablet benfotiamine 100mg
nicotine gums 2 mg
NON PHARMACOLOGICAL INTERVENTIONS
Complete blood picture
Liver functin tests
Renal function tests
Serum lipase and serum amylase test
Ultrasound
Bed rest
Monitoring
Physician presence
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