Patient B., A 27-year-old female, has complaints of abdominal pain radiating to her back after a meal (especially junk food), weight lost, greasy, foul-smelling stool, general fatigue.
Anamnesis: considers herself to be sick for 3 years now, she had experienced multiple previous admissions for similar pain. She was prescribed treatment in her previous admissions, but never followed any diet, did not take any medications. She took paracetamol for pain relief, but it never helped much. For the past 2 months she started noticing that her stool was greasy, bulky, floaty, took a few attempts to flush it in the toilet, she felt more tired than usual.
Anamnesis vitae: grew and developed normally. Bad habits: smokes 10 cigarettes a day. She had a significant history of alcohol abuse and consisting of a bottle of whiskey consumed over a week on average for the 3 years prior to presenting complaint of pain. She does not consume alcohol for the past 3 years, stopped drinking after her first admission to the hospital due to severe epigastric pain radiating to her back. Family history: her mother died of stroke, her father suffered from chronic pancreatitis and COPD.
Upon examination: condition of moderate severity. The patient is of asthenic constitution. Her height is 1.63 cm, her weight is 50, BMI is 18,8 kg/m 2.The skin and visible mucous membranes are of normal color, clean, dry. Auscultation of the lungs: vesicular lung sound, no wheezing. Respiratory rate is 15 per minute. Heart sounds are clear, no murmurs, the heart rate is regular, 76 beats / min. BP 115/75 mm Hg. The tongue is coated with white. The abdomen on palpation is soft, epigastric tenderness is found. Peritonitis symptoms are negative. The liver is not enlarged. The spleen is not enlarged. The stool is greasy, foul-smelling.
Blood analysis: hemoglobin 14,6 g / dL, RBC - 4.5 × 1012 / L, WBC - 9.2 × 109/ L, neutrophils - 60%, eosinophils - 1%, lymphocytes - 30%, monocytes - 8%, eos – 1 %, basos –2 %, ESR - 10 mm / h.
Biochemical profile: urea – 5,7 mmol/L, creatinine – 0,9 mg/dL, total protein – 7,2 g/dL, cholesterol – 190 mg/dL , AST – 26 U/L, ALT – 25 U/L, amylase – 200 U/L
Urinalysis: normal.
Ultrasound of the abdominal organs: the size of the liver is not enlarged, the contours are even, its parenchyma has a homogeneous low echogenic structure. The portal vein is not dilated (0.7 cm in diameter). The gallbladder is of normal size and shape, no stones. The common bile duct is not dilated (about 6 mm). An increase in the echogenicity of the pancreas and an increase in the size of its head and body with uneven contours are noted.
Questions.
1. Formulate a preliminary diagnosis, justify your answer.
2. List the necessary additional examination methods to clarify the diagnosis, justify your choice.
3. Assign treatment by specifying the groups of drugs, with an example of a drug and its prescribing scheme.
4. With what diseases it is necessary to conduct a differential diagnosis. List the main diseases and a list of distinctive clinical and laboratory indicators.
Answers
Explanation:
abdominal pain radiating to her back after a meal (especially junk food), weight lost, greasy, foul-smelling stool, general fatigue.
Anamnesis: considers herself to be sick for 3 years now, she had experienced multiple previous admissions for similar pain. She was prescribed treatment in her previous admissions, but never followed any diet, did not take any medications. She took paracetamol for pain relief, but it never helped much. For the past 2 months she started noticing that her stool was greasy, bulky, floaty, took a few attempts to flush it in the toilet, she felt more tired than usual.
Anamnesis vitae: grew and developed normally. Bad habits: smokes 10 cigarettes a day. She had a significant history of alcohol abuse and consisting of a bottle of whiskey consumed over a week on average for the 3 years prior to presenting complaint of pain. She does not consume alcohol for the past 3 years, stopped drinking after her first admission to the hospital due to severe epigastric pain radiating to her back. Family history: her mother died of stroke, her father suffered from chronic pancreatitis and COPD.
Upon examination: condition of moderate severity. The patient is of asthenic constitution. Her height is 1.63 cm, her weight is 50, BMI is 18,8 kg/m 2.The skin and visible mucous membranes are of normal color, clean, dry. Auscultation of the lungs: vesicular lung sound, no wheezing. Respiratory rate is 15 p