Clinical Cases

Acute Pancreatitis in a Woman of 22

Dr. Ahsan K.A. presents a case of acute pancreatitis in a woman of 22. Iris Tenax proved effective in treating this case.

Keywords: Acute Pancreatitis, IrisTenax.

INTRODUCTION

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. Mild acute pancreatitis consists of minimal or no organ dysfunction and an uneventful recovery. Severe pancreatitis manifests as organ failure and/or local complications such as necrosis, abscess, or pseudocyst. Overall, about 20%of patients with acute pancreatitis have a severe course, and 10% to 30% of those with severe acute pancreatitis die.

INCIDENCE

Male: female ratio is 1:3 in those with gallstones and 6:1 in those with alcoholism.

AETIOLOGY

Non–traumatic(75%)

  • Biliary tract diseases
  • Alcohol
  • Viral infections (EBV,CMV,mumps)
  • Drugs (Steroid,thiazide)
  • Scorpion bites
  • Hyperlipidemia
  • Hyperparathyroidsim

Traumatic(5%)

Idiopathic(20%)

PATHOLOGY

INITIATING PHASE

-Activation of the intra pancreatic digestive enzymes

– Acinar cell injury, it acts as inflammatory and the injured cells generate cytokines and chemokines

PERPETUATING PHASE

-Events perpetuating inflammation involves recruitment of leucocyte

– Neutrophils, lymphocytes and monocytes escalate the local inflammation

THIRD STAGE

-Proteolysis, oedema, interstitial haemorrhage, necrosis

CLINICAL FEATURES

The most common symptoms and signs include:

  • Severe abdominal pain (mostly over the epigastric region) radiating to back.
  • Nausea
  • Vomiting
  • Loss of appetite
  • Generalised weakness
  • Fever

Signs which are less common and indicates severe disease, include (Inspection)

  • Grey-Turner’s sign (Hemorrhagic discolouration of the flanks)
  • Cullen’s sign (Hemorrhagic discolouration of the umbilicus.1

  • P/A – ON Palpation
  • Muscle guarding present
  • Tenderness

CASE

PRELIMINARY DATA

Name : MRS.F A

Age: 22 Years

Sex: Female

Education: PUC Occupation: House wife Religion: Islam

Marital Status: Married

Date and Time of admission: 13-06-2019 at 6:15PM

IP NO: 1007094

CHIEF COMPLAINT

Patient presented with the complaints of abdominal pain and vomiting for the last 3 days.

Past Medical History: Chickenpox 15 years of age.

Past Treatment History: Allopathic Medication for the same.

Past Surgical History: Appendicectomy done 5 years back.

Family History: Mother: Type II DM And Hypertensive 7/29/2020.

Personal History

▪ Diet: Mixed; Appetite: Good.

▪ Thirst: Half Litre Per day but increased since 3 days.

▪ Craving: Spicy food 2+; Aversion: vegetables2+

▪ Bowel habits: once/ day. Bladder habit: 4- 5times/day, 2times at night, no difficulty. Perspiration: Generalised

▪ Sleep: Good. Dreams: unremembered

▪ Thermal: Hot patient

MenstrualHistory

  • FMP: 12 years; LMP: 27/5/2019 (Regular cycle, 6 days flow, 2 pads/day).

ObstetricalHistory: G0 P0 L0 A0 D0

General Physical Examination

  • Well oriented with time, place and person.
  • Moderately built and nourished.
  • No signs of pallor, cyanosis, clubbing, icterus, oedema and lymphadenopathy.

Vital-signs

  • Temperature: Afebrile at the time of examination
  • P: 110/80mmHg ;
  • Pulse: 90/minute;
  • Spo2 : 99%
  • Weight :48kg

Per abdominal Examination

  • Inspection: Surgical scar marks present over the right iliac area.
  • Palpation: Tenderness over the epigastrium, umbilical, left lumbar, hypogastrium, right and left iliac regions.
  • Muscle guarding present.

INVESTIGATIONS DONE ON 13-06-2019

  • Total Leukocyte Count: 19.24*10^3/μL
  • Neutrophil: 75.6%
  • Lymphocyte: 16.4%

2. USG- Abdomen: Partially distended gall bladder.

  • Impression: No sonological abnormality detected.

3. Urine analysis: Normal

4.Serum Amylase : 140 IU/L

SPECIFIC MANAGEMENT

Robin Murphy- Homoeopathic medical repertory

CHAPTER:

 GLANDS/CLINICAL

RUBRIC:

 PANCREATITIS

SUB RUBRIC :

 ACUTE

 REMEDIES:

             Bell, con,  iris 2

REPERTORIAL RESULT

13/06/19 at 6 pm – Medicine Prescribed

Rx;

  1. IRIS TENAX 6 (1 packet /4th hourly)
  2. MAG PHOS 6X for pain

13/16/19 at 8pm

  • C/o 2 episodes of vomiting after food
  • Nausea present
  • Pain abdomen persisting

Rx

1.IVF –RL 1 POINT 75 ml/hr

2.Continue the same treatment.

14/06/19 at 8:45 AM

  • c/o Abdominal pain better
  • c/o Weakness better
  • c/o Nausea better; No new episodes of vomiting
  • Appetite: good
  • Thirst: good
  • Bowels and bladder habits: Good
  • Sleep: Good
  • O/E : P/A : – Tenderness and guarding reduced

Investigations CBC advised

Rx

  1. IRIS TENAX 6 ( 1 packet /4 hourly)
  2. MAG PHOS 6X for pain

14-06-2019

  • COMPLETE BLOOD COUNT
  • HB:12.2 G%
  • Total Count : 9800/cmm
  • Neutrophils : 68%
  • Lymphocytes: 27%
  • ESR : 50 mm/1st Hour

15/06/19 at 8:45 AM

  • C/o Pain abdomen reduced
  • C/o Weakness reduced
  • No nausea; No new episodes of vomiting
  • Appetite: good
  • Thirst: good
  • Bowels and bladder habits : good
  • Sleep: refreshed
  • O/E –No tenderness over abdomen

Rx

  1. IRIS TENAX 6 (1 packet /4 hourly)
  2. MAG PHOS 6X for pain

iii. Advised SERUM AMYLASE

  • 15-06-2019

Serum Amylase : 80 IU/L

  • 15-06-2019 : Patient discharged with following medications and diet

Rx;

  1. IRIS TENAX 6 (1-1-1) for 1 week

2..MAG PHOS 6X for pain

3.Avoid Non veg and oily foods.

4.Review on 24-06-2019 on Medicine OPD.

FOLLOW UP ON 24-06-2019

  • C/o Pain abdomen reduced
  • C/o Weakness reduced
  • No nausea; No new episodes of vomiting
  • Appetite: good
  • Thirst: good
  • Bowels and bladder habits: Good
  • Sleep: Refreshed
  • O/E –No Tenderness over abdomen

No new complaints. Generally good.

Rx,

1.Mag phos 6x – 2 tablets (S.O.S for pain)  for 1 week.

2.Avoid oily and fatty foods.

CONCLUSION

This is a case of 22 years old female who presented with acute abdomen and was diagnosed as acute pancreatitis.   The specific remedy was Iris Tenax 6.

REFERENCE

1.Y.P Munjal; API Text Book of Medicine; Page no: 813;9th edition; Jaypee Brothers Medical Publishers (P) Ltd.

2.N.D Robin Murphy; Homoeopathic Medical Repertory;3rd Revised   Edition; B-Jain large print (P) Ltd.

About the author

Ahsan K A

Dr Ahsan K A, MD -Scholar, Department of Practice Of Medicine,
Father Muller Homoeopathic Medical College and Hospital, Mangalore.

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