Case 37: Enrico Castallani

INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history, conduct an appropriate examination and then outline your management plan to Mr Castallani.

The following information is on his summary sheet:

• Past medical history

• MVA 2015—sustained no injuries, cause of accident unclear

• Medications

• Nil recorded

• Allergies

• Nil known

• Immunisations

• Nil known

• Social history

• Local hotelier

• Lives with de facto partner.

INSTRUCTIONS FOR THE PATIENT, ENRICO CASTALLANI

You have been the licensee of a hotel for the last two years. You rarely see the doctor. Today you have asked for an urgent appointment because of bad abdominal pain.

For the last 24 hours you have experienced constant severe abdominal pain, which radiates through to your back. The pain has been so bad that you can’t work or walk. You have come today because your partner has persuaded you. You have been vomiting and are off your food. You cannot get comfortable, and you are sweating and feel generally weak.

You have not vomited blood and have no symptoms or signs of liver failure. You are very sensitive about your alcohol problem and will only open up about this if the doctor approaches the issue in a non-judgemental manner.

You have a long-term drinking problem. Both your parents were alcoholics and although you saw the impact of alcohol on them, you started drinking at a young age. You have had a series of jobs working in the hospitality industry. You left your last job in a hurry as you had a car accident while drunk. No one was injured in the crash, but there was significant damage to the car and public property; the police were never able to establish a cause, but you left the town to escape suspicion.

For the past few months you have switched to drinking port rather than wine. You have about a cask a day.

The following information is on your summary sheet:

• Past medical history

• MVA 2015—sustained no injuries, cause of accident unclear

• Medication

• Nil recorded

• Allergies

• Nil known

• Immunisations

• Nil known

• Social history

• Local hotelier

• Lives with de facto partner.

INSTRUCTIONS FOR THE FACILITATOR

This is a case of acute pancreatitis. Please give the candidate the following examination findings on specific request.

Clinical examination findings

Temperature 38.0°C, sweating

Pulse ...