Ahmed abdul hadi 120080864

History:
Ibrahim Mohammed kauraa is sixteen year-old male, single lives in Khan younis and he is a
student.
He was admitted from ER to male medical ward in European Gaza hospital on Sunday
10/11/2013 at 8:00 PM.
The history was taken from the patient himself who was reliable and informative by a sixth
year medical students Ahmed abdul hadi.

File No. 11594

Chief Complaint: Abdomen pain and feverish sensation for 1 days.

History of Present Illness:
The patient relatively will until five days prior to admission when he started to suffer from
abdominal pain and feverish sensation .
He suffered from rapid onset of localize slightly sever epigastric constant abdominal pain which
was increased in flat position and decreased when the patient was leaning forward and it
radiated to back and was not refer. It was associated with non-projectile yellowish vomiting
without blood or coffee ground appearance.
He also complains of feverish sensation which was contentious and progressive and was not
documented by patient.
These symptoms was precede 2day ago by unilateral painful right submandibular swelling it
was hot and red and the pain was constant progressive in nature, refer to his ear and was not
increased by salivation or other factors.
There were no headache, neck stiffness, loss of hearing, testicular pain and rash.
There were no histories of anorexia or weight loss.

Review of system:
Cardiovascular: no cyanosis; no history of murmurs.
Respiratory: no cough, no wheezing, no shortness of breath.
Neurological: no seizures; no spasms.
Musculoskeletal: no pain and no fractures.
Endocrine: No heat or cold intolerance, no weight loss, no polyuria and no polydepsia

Past medical history:

No history of similar attack.
No history of other chronic disease.
No history of blood transfusion.
No history of surgical operations.

Drug history:
No history of drug use.
No history of drug or food allergy.
Ahmed abdul hadi 120080864

Family history:
No history of similar attack in his family.
No history of chronic disease in his family.
No history of sudden death.
No history of hereditary disease in his family.
There is no consanguinity between his father and mother.
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16 10
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Social history:
Patient lives in the ground floor with his father and mother . They have good water, electricity
and ventilation. There are no pets in the home, and there are no smokers in his family. They
have medical insurance and his parents have secondary school level.

Physical examination:
Vital signs:
Temperature: 39 C Respirations: 22 cycle/min
Pulse: 90 beat/min BP: 130/70

General:
The patient looks well but in pain, conscious and oriented
There was no pallor no cyanosis and no jaundice.

Head and neck examination:

There was unilateral swilling anterior and underneath the right mandibular angle and it was
reddish in color there was no scar, no ulcer, no visible vain, no visible pulsation.
It was tender, hot, soft, diffuse, mobile mass without well edges and about 5X5 cm.

Abdomen
Inspection: It was symmetrical with abdominal-thoracic respiration. There are no abdominal
distention, no abnormal discoloration, no visible peristalsis or pulsation, no scar or dilated
veins.
Umbilicus centralized, normal color and no inflammation.

Palpitation:
Superficial: normal temperature, no mass and there is tenderness in epigastric area.
Deep: tenderness in epigastric area, no deep masses
Organ: no splenomegaly, no hepatomegaly and the kidney was normal
Ahmed abdul hadi 120080864

Lymph node and hernia orifice: no lymphadenopathy or hernia.

Percussion: no ascites and the liver span normal 8 cm, and no splenomegaly
Auscultation: normal bowel sounds and no bruit.

Investigation

CBC
WBC: 7.4 x 103 / UL
RBC:4.2 x 106 / UL
Platelet: 203 x 103 / UL
HGB: 14.4 g/dl
HCT: 42.8

Glucose: 92 mg/dl

Urea: 45 mg/dl
Cr: 1.2 mg/dl

Amylase: 450 U/L

Management:
Definitive diagnosis: Mumps and acute pancreatitis

Ranitidine: 50 mg IV Q 12h.
Metoclopramide: 10mg IV Q 12h.
Normal saline: 500cc IV Q 8h.

Follow up:

First day
Subjective: Pain and fever decrease and there was no vomiting or loss of consciousness.
Objective: The patients looks well, stable, comfortable, oriented and his vital signs improve and
fever less (T: 37.2 C, RR 14 cycle/min, PR 85 beat/min, BB 115/70 )
The mass become less tender and the redness decrease and less warm but in the same size and
character.
Abdominal examination: soft and lax and the tenderness in the epigastric area improve.
Heart and chest was normal.
Meningeal signs negative and no any neurological signs.
Assessment: review the results of old investigation
Plan: Urine analysis, liver function, electrolytes and repeated amylase

Second day:

Subjective: Patient was not complaining, no vomiting and no fever and no abdominal pain.
Ahmed abdul hadi 120080864

Objective: looks well comfortable stable, normal vital signs, the mass begin to shrink and
abdomen soft and lax and without tenderness, neurological system normal and without
meningeal signs.

Assessment:
Urine analysis:
WBC: 3
RBC: 1
Casts: 0
Bacteria or cyst: none seen

Pancreatic enzyme:
Amylase: 320 U/L

Liver function:
LDH: 340 IU/L
AST: 40 U/L
ALT: 35 U/L
Conjugated bilirubin: 0.3 mg/dl
Unconjugated bilirubin: 0.7 mg/dl

Electrolytes:
Na: 140 mEq/L
K: 3.5 mEq/L
Calcium: 9 mg/dl

Plan:
Stop IV fluids.
The clinical picture and lab results were improving so still him for next day and if he is stable and no any
complain we will discharge him.

Third day: The patient was well and stable so we decide to discharge him on parcetamol 500mg and we advise
him that he will recover completely within week and if he suffers from any complication he can review us.