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Abstract: The patient suddenly developed persistent abdominal pain with nausea and vomiting more than 6 hours before the consultation, and after self-treatment with heart and stomach pain capsules and Xiang Sha Yang Gastric Pills with poor results and increased abdominal pain, he immediately went to our emergency room. The ultrasound of liver, gallbladder, pancreas and spleen showed pancreatitis, so he was treated with anti-inflammatory, rehydration, lipid-lowering and suppression of pancreatic and gastric acid secretion for 3 weeks, and was discharged with good recovery and improvement of all indexes.
Basic information】Male, 41 years old
Disease Type】Pancreatitis
Hospital】The First Hospital of China Medical University
Time of consultation】December 2018
【Treatment plan】Intravenous injection (ceftriaxone sodium for injection, sodium lactate ringer injection, sodium chloride glucose injection, octreotide acetate injection, omeprazole sodium for injection) + oral medication (fenofibrate tablets, benzofibrate dispersible tablets)
[Treatment period] Hospitalization for 3 weeks
Effectiveness of treatment】Good recovery and improvement of all indexes
I. Initial consultation
The patient, a 41-year-old male, was hospitalized in our department for “abdominal pain” in April and July 2018, and was diagnosed with hyperlipidemic pancreatitis after completing the auxiliary examination, which improved after treatment, and has been treated with oral lipid-lowering tablets for the past 5 months. This visit was due to the sudden onset of persistent epigastric pain more than 6 hours ago, which spread from the middle of the upper abdomen and the left side of the upper abdomen to the top of the navel, accompanied by nausea and vomiting once, and the abdominal pain was slightly relieved after vomiting, without symptoms such as acid reflux, heartburn and diarrhea. He took heart and stomach pain relief capsule and Xiang Sha Yang Gastric Pill for treatment, but the effect was not good and the abdominal pain worsened, so he immediately went to our emergency room. On examination, he found significant pressure pain in the middle of the upper abdomen and the left upper abdomen without rebound pain, abdominal percussion and drum sounds, and about 3-4 bowel sounds/min on auscultation.
II. Treatment history
After completing the relevant examination after admission, it was found that the triglycerides were significantly increased, which belonged to pancreatitis caused by hyperlipidemia, and I told the patient that pancreatitis could be relieved by conservative treatment. After the patient and his family agreed, I gave him ceftriaxone sodium for injection for anti-inflammatory treatment, sodium lactate Ringer injection and sodium chloride glucose injection to replenish body fluid and maintain electrolyte balance, and parenteral nutrition support, octreotide acetate injection to inhibit pancreatic secretion, omeprazole sodium for injection to inhibit gastric acid secretion, and fenofibrate tablets and benzofibrate dispersible tablets to lower triglycerides. After 3 weeks of hospitalization, the patient was discharged from the hospital in good condition.
III. Treatment effect
The patient had persistent abdominal pain as well as nausea and vomiting symptoms before treatment. After 3 days of infusion treatment, the patient immediately reported that the symptoms were reduced, which indicated that the above treatment was effective and could continue infusion treatment. After 3 weeks of anti-inflammatory treatment, fluid supplementation and suppression of pancreatic and gastric acid secretion, the patient reported that the persistent abdominal pain and symptoms of nausea and vomiting had completely disappeared. On examination, he found that the pressure pain in the middle of the upper abdomen and the left upper abdomen and the audible bowel sounds disappeared, and the blood lipid examination showed that the indicators improved, so he was discharged.
IV. Notes
I was very happy for the patient that he could be discharged from the hospital to recuperate from his illness. However, since pancreatitis can recur and the patient has had several episodes of pancreatitis, in order to help the patient reduce the possibility of recurrence of pancreatitis, we need the patient to pay attention to some matters after discharge. First of all, in terms of diet, you must avoid eating spicy and stimulating food, and try to eat less greasy and cold food, it is best to focus on light and low-fat food, and eat regularly to avoid being too hungry and too full, to reduce the stimulation of the body, which is beneficial to health. In addition, it is necessary to avoid smoking and drinking alcohol to prevent the recurrence of pancreatitis.
V. Personal insight
There are many causes of pancreatitis, such as long-term alcohol consumption, infection or metabolic disorders, and the patient in this case was initially caused by hyperlipidemia among metabolic disorders. Although the patient was discharged from the hospital after anti-inflammatory, rehydration, lipid-lowering and pancreatic and gastric acid suppression treatments, if the patient still does not pay attention to weight loss and lipid control, it may still lead to recurrence of pancreatitis. Therefore, in addition to medication, lifestyle changes are also important for patients with this type of pancreatitis. If you adhere to a low-fat diet and exercise appropriately after treatment, there is a greater chance that pancreatitis will not recur.