Chandana vishwanatham

  Speaker notes pancreas Slide 2: • 50 Year old male came with complaints of : •   Abdominal distension with pain abdomen since 1 week •   Loss of appetite since 1 week •   Shortness of breath since 1 week •   B/L lower limb swelling since 5 days •   Decreased urine output since 5 days HOPI • Patient was apparently asymptomatic one week back then he noticed abdomeninal distention which was diffuse associated with abdominal pain( squeezing type ) not associated with vomotings, loose stools, fever Aggravated with food intake •   Complaints of bilateral pedal edema which is pitting type gradually progressive, extending from ankle to knee joint •   C/o decreased urine output and yellowish discolouration of urine since 5 days not associated with fever with chills and burning miturition, frothing of urine •   Complaints of shortness of breath with grade Il which is decreased in supine position • No h/o chest pain, palpitations, excess

  Slide 1,2: Good morning everyone After an extensive case presentation by Dr.Raveen ,we are also as confused as you people ,with the diagnosis.That is the complexity we want to show you all. So here we stand in the centre of the slide confused with our differentials. Initial suspicion was Auto immune spectrum of diseases,Vitamin b12 deficiency  Later due to progressive splenomegaly Treatment was also given for tropical splenomegaly and NCPF was considered. Other differentials like CVID,Rosai drofman were also considered in between And in the end the biopsy came out to be likely storage disorder and NCPF. Slide 3:  Vitamin B12 deficiency:Always think about commoner ones first and rarer ones later.Even though patient was not having any sensory symptoms,Hemogram not suggestive of vitamin B12 deficiency.Yet B12 deficiency is considered because we see many cases of B12 deficiency presenting with Pancytopenia and splenomegaly and response to treatment is the main diagnostic feature of B12 d