**Chief Complaint**: Severe abdominal pain and vomiting
**History of Presenting Illness**: A 45-year-old male with a history of hypertension and type 2 diabetes presented with sudden onset of severe abdominal pain radiating to the back, accompanied by nausea and vomiting. Symptoms began 12 hours prior to admission. The patient reports no alleviating factors and states the pain is constant and severe.
Detailed history of investigations and findings performed in the emergency department or transferring facility: The patient was administered IV fluids and antiemetics in the emergency department. A CT scan revealed signs of acute pancreatitis. The patient was admitted to the Hospitalist team for further management.
**Past Medical History**: Hypertension, Type 2 Diabetes
**Home Medications**: Lisinopril 10 mg daily, Metformin 500 mg twice daily
**Allergies**: No known drug allergies
**Social History**: The patient is a non-smoker, consumes alcohol occasionally, is married, and lives with his spouse and two children.
**Family History**: Father had a history of coronary artery disease.
**Review of Systems**:
Constitutional symptoms: Reports fatigue and malaise
Eyes: No symptoms
Ears, Nose, Mouth, Throat: No symptoms
Cardiovascular: No chest pain or palpitations
Respiratory: No cough or dyspnea
Gastrointestinal: Reports nausea, vomiting, and abdominal pain
Genitourinary: No symptoms
Musculoskeletal: No symptoms
Integumentary (Skin): No symptoms
Neurological: No symptoms
Psychiatric: No symptoms
Endocrine: No symptoms
Hematologic/Lymphatic: No symptoms
Allergic/Immunologic: No symptoms
**Physical Exam**:
Vitals: Blood pressure 140/90 mmHg, Heart rate 95 bpm, Temperature 37.5°C
Abdominal examination: Tenderness in the epigastric region, guarding present
**Lab Results**:
Elevated serum amylase and lipase levels
**Imaging Results**:
CT scan of the abdomen showed inflammation of the pancreas consistent with acute pancreatitis
**Assessment/Plan**:
1. Acute Pancreatitis
- Impression: Acute pancreatitis
- Differential diagnosis: Gallstone pancreatitis, Alcohol-induced pancreatitis
- Investigations planned: Liver function tests, Ultrasound of the abdomen
- Treatment planned: NPO (nil per os), IV fluids, Pain management with analgesics
- Relevant referrals: Gastroenterology consult
**Two Midnight Documentation**
The patient's stay will likely span more than 2 midnights in the hospital because of the severity of illness.
**Time Spent**
Total time spent: 1 hour
