35year old male with chronic pancreatitis,fever with unknown origin

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A 35 year old man, works at a wedding card printing store, presented to the casualty at 8pm with the  complaints of Fever since 2 months
Generalized weakness since 2 months 
Dyspnea on exertion since 2 months 
Pain abdomen since 20 days
Right sided chest pain since 20 days
Vomiting since 20 days 
Dark coloured stools since 20 days
Personal history
He works at a store that prints wedding cards at Suryapet. He has 2 daughters. Since the past 15 years he has been consuming alcohol everyday, he consumes around 360ml of whiskey per day and his last alcohol intake was yesterday.
Since 15 years he has been smoking, he says he only smokes occasionally. 
Since the past 2 years he started to experience  loss of appetite. He also tells us that he started consuming less food and started to consume larger amounts of alcohol. He also tells us that he started to experience recurrent episodes of pain abdomen along with recurrent episodes of vomiting every alternate day and he has visited hospitals 5-6 times over the past 2 years. 
Since the past 2 months he has been experiencing dyspnea on exertion, he says he started to feel dyspneic on walking short distances of less than 100m and also started to experience generalized  weakness so much so that he stopped going for work.
He also tells us that over the past 2 months he has been experiencing low grade fever along with loss of around 12kgs.

20 days back he complains of  one episode of blood tinged vomitus and has been experiencing increased pain abdomen in his epigastric and right hypochondriac region along with right sided chest pain.
He also complains of black tarry stools since 20 days.

On examination- 
He is a thin built man 
PR - 84bpm, regular
BP - 120/80mmhg
RR - 18cpm
Temp - 98.4 F
Spo2 - 98% on Room Air
Grbs - 102 mg/dl
Pallor +
2 Hypopigmented patches over his abdomen- he has been having them since childhood, pain sensation +

Per Abdomen- 
Diffuse tenderness  +
Guarding +
Bowel sounds +

Cvs - 
Palpable P2 +
Apex beat in 6th ICS at MCL
S1,S2 +
ESM +

Lungs - 
BAE +
Clear
Provisional diagnosis-
Chronic pancreatitis with 
Pyrexia of unknown origin 
Anemia under evaluation ( -  Secondary to GI blood loss and Nutritional)  
 Heart failure

Hb- 3.8 
TLC - 13,500
Plt - 4.8

Peripheral smear - Anisopoikilocytosis with hypochromasia, microcytes with tear drop cells, pencil cells with target cells and few normocytes

LDH - 363

Retic count - 1.8
Serology negative

LFT - 
Tb - 0.47
Db - 0.18
Ast - 23
Alt - 10
Alp - 161
TP - 5.4
Alb - 2.9
A/G - 1.19
ECG
Chest x-ray
2D-ECHO
SOAP NOTES DAY 1 

S
Pain abdomen subsided,fever spike,did n't stools 

O
BP -130/90MM HG
PR- 120BPM
TEMP- AFEBRILE
CVS -S1,S2 HEARD
RS- BAE+
CNS-NAD
PER ABDOMEN-SOFT,NON TENDER

A
?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY
MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P
1.IVF NS,RL 100+50ML/HR
2.INJ.PAN 40MG IV BD
3.INJ.ZOFER 4MG IV SOS
4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS
5.INJ.THIAMINE 1AMP IN 100ML NS IV OD
6.TAB.DOLO 650MG PO SOS
7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD
8.TAB.LORAZEPAM 2MG SOS
9.TAB.PREGABA -M 75MG
SOAP DAY 2
S
Pain abdomen subsided,fever spike+,passed stools

O
BP -150/100MM HG
PR- 110BPM
TEMP- 99.8
CVS -S1,S2 HEARD
RS- BAE+
CNS-NAD 
PER ABDOMEN-SOFT,NON TENDER

A
?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY
MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P
1.IVF NS,RL 100+50ML/HR
2.INJ.PAN 40MG IV BD
3.INJ.ZOFER 4MG IV SOS
4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS
5.INJ.THIAMINE 1AMP IN 100ML NS IV OD
6.TAB.DOLO 650MG PO SOS
7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD
8.TAB.LORAZEPAM 2MG SOS
9.TAB.PREGABA -M 75MG



S-
No fresh complaints 

O
BP -140/90MM HG
PR- 90bpm
TEMP- 98.4
CVS -S1,S2 HEARD
RS- BAE+
CNS-NAD
PER ABDOMEN-SOFT,NON TENDER

A
?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY
MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P
1.IVF NS,RL 100+50ML/HR
2.INJ.PAN 40MG IV BD
3.INJ.ZOFER 4MG IV SOS
4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS
5.INJ.THIAMINE 1AMP IN 100ML NS IV OD
6.TAB.DOLO 650MG PO SOS
7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD
8.TAB.LORAZEPAM 2MG SOS
9.TAB.PREGABA -M 75MG


S
Pain abdomen subsided

O
BP -120/80MM HG
PR- 90BPM
TEMP- 98.8
CVS -S1,S2 HEARD
RS- BAE+
CNS-NAD
PER ABDOMEN-SOFT,NON TENDER

A
?ACUTE PANCREATITIS WITH SEVERE ANAEMIA SECONDARY TO ?NUTRITIONAL DEFICIENCY
MICROCYTIC HYPOCHROMIC ANEMIA,HFPEF WITH EF 60 percent,(SECONDARY TO SEVERE ANEMIA)

P
1.IVF NS,RL 100+50ML/HR
2.INJ.PAN 40MG IV BD
3.INJ.ZOFER 4MG IV SOS
4.INJ.TRAMADOL 1AMP IN 100ML NS IV SOS
5.INJ.THIAMINE 1AMP IN 100ML NS IV OD
6.TAB.DOLO 650MG PO SOS
7.INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD
8.TAB.LORAZEPAM 2MG SOS
9.TAB.PREGABA -M 75MG





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