Concluded Case

ACUTE ABDOMINAL PAIN

C/o A 56-year-old woman complaining of abdominal pain. Twenty-four hours previously she developed a continuous pain in the upper abdomen which has become progressively more severe. The pain radiates into the back. She feels nauseated and alternately hot and cold. H/o duodenal ulcer which was successfully treated with Helicobacter eradication therapy 5 years earlier. on Examination... The patient looks unwell and dehydrated. She weighs 115 kg. She is febrile, 38.5°C, pulse is 108/min and blood pressure 124/76 mmHg. She is tender in the right upper quadrant and epigastrium, with guarding and rebound tenderness. Bowel sounds are sparse. What is the most likely diagnosis?

LikeAnswersShare
Concluded answer
In this patient the leucocytosis and raised CRP are consistent with acute cholecystitis. If the serum bilirubin and liver enzymes are very deranged, acute cholangitis due to a stone in the common bile duct should be suspected. The abdominal X-ray is normal; the major- ity of gallstones are radiolucent and do not show on plain films.
All Answers
This woman has acute cholecystitis. The major differential diagnoses of acute cholecystitis include perforated peptic ulcer, acute pancreatitis, acute hepatitis, subphrenic abscess, retrocaecal appendicitis and perforated carcinoma or diverticulum of the hepatic flexure of the colon. Myocardial infarction or right lower lobe pneumonia may also mimic cholecystitis. Acute cholecystitis typically causes right upper quadrant pain and a positive Murphys sign. @Pushker Bhomia @Shivraj Agarwal
In all probabilities she looks to be a c/o ACUTE ABDOMEN likely due to perforation of DU KUB is not displaying domes to look gas under the diaphragm No gas shadows in intestinal loops seen likely ac peritonitis with ileus Clinical history suggest hot and cold episodes of unstable condition Pt should be hospitalised and screened and managed in emergency
I agree
0

View 3 other replies

Perforated ulcer gas under diaphragm
In this patient the leucocytosis and raised CRP are consistent with acute cholecystitis. If the serum bilirubin and liver enzymes are very deranged, acute cholangitis due to a stone in the common bile duct should be suspected. The abdominal X-ray is normal; the major- ity of gallstones are radiolucent and do not show on plain films.

Cases that would interest you