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Studi Kasus

Bill Jones, a 48-year-old man, presented with intense abdominal pain and vomiting. Laboratory results were consistent with acute pancreatitis, precipitated by heavy alcohol use the night before. The goals of therapy are to treat the pancreatitis, monitor for complications, and provide pain management and hydration. Key parameters to monitor include the patient's vital signs and laboratory values.

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Julian Felix
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353 views3 pages

Studi Kasus

Bill Jones, a 48-year-old man, presented with intense abdominal pain and vomiting. Laboratory results were consistent with acute pancreatitis, precipitated by heavy alcohol use the night before. The goals of therapy are to treat the pancreatitis, monitor for complications, and provide pain management and hydration. Key parameters to monitor include the patient's vital signs and laboratory values.

Uploaded by

Julian Felix
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Case A

Chief Complaint : “I’ve got a really bad pain in my stomach.”


HPI (History of present illness) : Bill Jones is a 48-year-old man who presents to the ED shortly after midnight
on a Friday night because of intense mid-epigastric pain radiating to his back. He states that the pain started
shortly after dinner the night before but has progressively worsened, and he began vomiting around midnight
tonight.
Present Medication History : Alcohol withdrawal seizures 8 months ago during which he suffered a small
subdural hematoma.
Family History : Father died at age of 56 from an MVA; mother is 72 years old and has Type 2 DM and
“cholesterol issues,” for which she is taking an unknown medication. One sister, also with “cholesterol issues,”
taking an unknown medication. The sister has a remote history of pancreatitis as well
Social history : Divorced with three children. Employed as a groundskeeper at a golf course. Denies any
smoking. He states that he used to consume six beers per day until 8 months ago when he had a withdrawal
seizure but now drinks only on weekends a total of about six beers; he reports sharing a couple of pitchers with
two friends last night with dinner. Drinks at least two cups of coffee each morning.
Medication history : Valproic acid 250 mg twice daily since his seizure, Advil 200 mg OTC several doses per day
PRN
Review of system : He states that he has been feeling well until last night. He hurt his back 2 weeks ago at
work but the Advil has helped relieve the pain. He has vomited approximately six times since midnight tonight. No
complaints of diarrhea or blood in the stool or vomit. No knowledge of any prior history of uncontrolled blood
sugars or cholesterol.
Vital Sign : BP 98/55, HR 122, RR 30, T 38.9°C; Wt 89 kg, Ht 5'10''
Lab test :
Na 128 mEq/L Hgb 17 g/dL AST 342 IU/L Ca 7.2 mg/dL
K 3.4 mEq/L Hct 50% ALT 166 IU/L Mg 1.7 mEq/L
Cl 105 mEq/ WBC 15.2 × 103/mm3 Alk phos 285 IU/L Phos 2.2 mg/dL
CO2 18 mEq/L Neutros 72% LDH 255 IU/L Trig 982 mg/dL
BUN 35 mg/dL Bands 4% T. bili 0.6 mg/dL Repeat Trig 1,010 mg/dL
SCr 1.5 mg/dL Eos 1% Alb 3.2 g/Dl PT 12.8 sec
Glu 375 mg/dL Basos 1% Prealb 25 mg/dL INR 1.1
Lymphs 20% Amylase 1,555 IU/L aPTT 19.3 sec
Monos 2% Lipase 2,220 IU/L

Urinalisis
Color yellow; turbidity clear; SG 1.010; pH 7.2; glucose >1,000 mg/ dL; bilirubin (–); ketones (–); Hgb (–); protein
(–); nitrite (–); crystals (–); casts (–); mucous (–); bacteria (–); urobilinogen: 0.25 EU/dL; WBC 0–5/hpf; RBC
0/hpf; epithelial cells: 0–10/hpf
Abdominal USG : Non-specific gas pattern; no dilated bowel. Questionable opacity/ abnormality of common bile
duct. Cannot rule out gallstone/ obstruction.
Assasement : Acute pancreatitis precipitating hyperglycemia, hypocalcemia, and non-anion gap metabolic
acidosis, R/O choledocholithiasis
Question :
a. What factors may have precipitated acute pancreatitis in this case?
b. What signs, symptoms, and laboratory tests are consistent with the diagnosis of acute pancreatitis?
c. What are the goals of therapy for this patient?
d. What parameter should be monitor ?
Case B

Chief Complaint : ““I’m here for my yearly visit, I’m not sick!”
HPI (History of present illness) : Ima Ferguson is a 56-year-old woman who presents to the clinic for her yearly
follow-up. The patient states that she feels fine and has been in her usual state of health since last clinic visit.
She also states she is not sure why she has to come to clinic every year, indicating; “There is nothing wrong with
me.” The patient’s former primary care provider has transferred to a different facility
Present Medication History : Morbid obesity (BMI 35.6 kg/m2), HTN for 24 years, IFG diagnosed 1 year ago
Osteoarthritis bilateral knees, Leg cramping >three blocks walking, Seasonal rhinitis since childhood
Perimenopausal—has OB/GYN screening yearly
Family History : Father; age 71 with Type 2 diabetes, COPD, hypertension
Mother; age 71 with advanced Parkinson’s, “heart disease” diagnosed at age 66
Patient does not have contact with her two younger brothers, their medical history is unknown Of her children, the
only significant medical history is one daughter with epilepsy.
Social history : Patient is a widow; she has four adult children, one of whom lives with her in her home along
with his three children Completed the 9th grade and provides day-care in her home. Denies alcohol, tobacco, or
illicit drug use.
Medication history : Enalapril 10 mg po BID, OTC potassium gluconate 595 mg po PRN for leg cramps,
Diphenhydramine 25–50 mg po PRN rhinitis, Ibuprofen 200 mg, 4 tabs po PRN HA, knee pain
Review of system : Patient states that she is in her normal state of health. She denies unilateral weakness,
numbness/tingling, or acute changes in vision (although over the course of the past year her vision prescription
has changed twice). She additionally denies CP, SOB, changes in bowel habits, or po intake. She states that she
has noticed more frequent leg cramps that begin after walking shorter distances than usual. In the past she was
able to walk ~6 blocks without pain, but now she gets cramping/pain walking just 2–3 blocks. She has also
noticed some swelling of the lower legs and feet, especially at the end of the day and has had increasingly
severe AM knee pain over the past several months. She admits to taking ibuprofen most days of the week.
Physical Examination :
General : Obese Caucasian woman in NAD
VS : BP 147/92, HR 83, RR 16, T 37.2°C; Wt 97 kg, Ht 5'5''
Skin : Warm and moist, normal turgor, acanthosis nigricans noted in axilla bilaterally
Lab test :
Na 142 mEq/L Ca 8.6 mg/dL WBC 5.3 × 103/mm3 Lipid Profile:
K 4.9 mEq/L Mg 2.1 mEq/L Hemoglobin 11.5 g/dL TC 259 mg/dL
Cl 104 mEq/L AST 34 U/L Hematocrit 34.6% HDL 37 mg/dL
CO2 24 mEq/L ALT 31 U/L Platelets 151 × 103/mm3 LDL 167 mg/dL
BUN 21 mg/dL T. bili 0.5 mg/dL TG 280 mg/dL
SCr 1.3 mg/dL T. prot 7.1 g/dL
Glucose 121 mg/dL

Urinalisis :
Yellow, clear, SG 1.003, pH 5.3, (–) protein, (–) glucose, (–) ketones, (–) bilirubin, (–) blood, (–) nitrites, RBC
0/hpf, WBC 1/hpf, no bacteria, 1–5 epithelial cells
Assasement :
Ms. Ferguson is an obese woman who presents to primary care clinic for her yearly exam. Patient has OA and
seasonal rhinitis, both of which she self-treats with OTC medications. She also has uncontrolled HTN, which is
currently treated with an ACE inhibitor. IFG was diagnosed last year. Patient has new onset anemia,
hyperlipidemia, renal insufficiency, and symptoms suggestive of possible PAD. When questioned about exercise
and dietary habits, the patient immediately became very defensive about her weight and stated that she is just
“big boned” and has a “slow metabolism.”
Question ;
a. What drug-related problems does this patient have?
b. What laboratory values indicate the presence and severity of hyperlipidemia in this patient?
c. This patient has been diagnosed with hyperlipidemia. What are her risk factors (both modifiable and non-
modifiable) for CV disease?
d. What is this patient’s risk classification for cardiovascular disease, and how does this relate to her individual
lipid goals?

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