40F with pancreatitis and HyperTriglyceridemia

This is a case of 40year old female resident of nalgonda who is a anganwadi teacher by occupation came to OP with complaints of pain abdomen since January 2023 and Nausea and vomitings since January 2023

Patient was apparently asymptomatic till feb 2020 , she was happily married since 2001 to a 45 year old male who used to be pharmacy incharge in our hospital for around 10years and now working at KHL with 2 daughters, eldest daughter was born in 2002 full term, Normal vaginal delivery and youngest daughter was born in 2004 full term due to rupture of membranes and delay in labour patient was taken up for LSCS and no complications were noted surgery and post surgery. And later tubectomy was also done in 2004.

Her routine life style used to be she wakes up around 6am followed by completes her morning routines such as bathing, brushing by 7am and prepares food and prepares children to get ready for school and she leaves to work by 10am and at anganwadi her work is to take care of students, writing registers and lunch break is from 1-2 and again comes to home by 4pm , if any meeting occurs she will reach home late around 6/7pm and prepares food and will have dinner and go to sleep around 10pm.

In 2018 , her routine menstrual history used to be 4-5/30 days but due to delay in her in menstrual period by 1 week and also due to diffuse pain in abdomen came here where she was diagnosed with ectopic pregnancy and surgery was done and advised bed rest for 3 months, but later that week she went to warangal and stayed there in a hostel for 1 week and still a mild abdominal used to persist which was relieved with medication. 

In starting of march 2020 she complained of pain abdomen which was in epigastric region and squeezing type, abdominal fullness and nausea + with no radiation, usg abdomen done showing no radiological abnormality and pain relieved with analgesic and Pantoprazole and she went to home after pain has been reduced. But later that march and in April she had similar complaints of pain abdomen and went to local hospital and went for CT abdomen and diagnosed with bulky acute pancreatitis diagnosed with CT severity index of 6/10. And immediately she was taken to Asian Institute of Gastroenterology by her husband , there on routine investigations she found to be having triglycerides of around 2215 and started her om fenofibrate and antioxidants and pancreatic enzymes. And again when she went for consultation her TG were around 1300 and rosuvastatin was started in September 2020 
In October she had H/o Covid 19 with complaints of fever, cold, cough and myalgias with anosmia which were relieved within 7 days. 

In 2021 and 2022 she was followed up with same doctor where she used to take all the same medication fenofibrate rosuvastatin antioxidants with tramadol SOS . And her frequency of this pain used to be 4-5 times in 3 months. 
In between one day her doctor advised to test her daughter for TGs and found to be elder daughter of 21 years with 643mg/dl and younger daughter of 19 years found with TGs of 665mg/dl.

Now since January 2023 , she is complaining of pain abdomen epigastric in region, squeezing in type, with abdominal distension and swelling near epigastric region (per se no hernia was noted on examination) and vomitings (pain abdomen which will be relieved after vomitings is noted) . Increased frequency of pain compared to previous and last episode was 2 days back. Her TG were on 3211mg/dl in March 2022 and in follow up 12/2022 - 2736 mg/dl 
No significant weight gain or weight loss present and had history of UTI 20 days back and relieved with medication. 

Her dietary life style :
8am - takes idly, dosa, jawa followed by 1 cup of tea 
1 pm - rice with dal, curry, chutney, sambar 
7pm - Raagi jawa, sanghati, gataka 
And complete Non veg has been stopped since 3 years.

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