45/F presented to ER with c/o Right upper & lower quadrant severe abdominal pain since 12.30 midnight a/w vomiting - 6 episodes h/o right flank pain radiating to lower abdomen. h/o palpitation+ no h/o fever/decreased urine output / burning micturition. ECG done showed this changes diagnosis and treatment?
Signs and symptoms are overlapping between abdominal cause of symptoms like acute appendicitis, acute cholecystitis, a perforated peptic ulcer considering the right sided pain . Also considering the ECG changes of sinus and bradycardia and inferior/ anterolateral myocardial ischaemia- patient needs to be thoroughly evaluated and managed .Investigations needed are 1.An X- ray abdomen standing to see gas under right dome of diaphragm 2.An ultrasound scan of abdomen to rule out acute cholecystitis- CHOLELITHIASIS and acute appendicitis besides pancreatitis. 3.A Trop - T test to evaluate Acute M.I 4.Echocardiography for cardiac evaluation
NSR, sinus bradycardia Anterior wall ischemia ECHO, electrolytes, TFT Clinical picture is suggestive of right ureteric colic , gall bladder disease, appendicitis . Bradycardia in such as situation is due to increased vagal tone .
ECG=SINUS BRADYCARDIA ADV DO USG OF WHOLE ABDOMEN TO RULE OUT APPENDICITIS. ?CHOLECYSTITIS RX START ANTIBIOTICS. CONSERVATIVE MANAGEMENT.
RT UPPER & LOWER ABD PAIN VOMITING++ O/ E MUSCLE GUARD ? MURPHEY'S SIGN ? RENAL ANGLE TENDERNESS ? MC BURNES TENDERNESS ? 45 YRS F = MENSTRUAL HISTORY = POSSIBLY = MENOPAUSE USG = ABDOMEN BLOOD = CBC URINE = ROUTINE C & S ECG = SINUS BRADICARDIA ST T ZCHANGES V3 ----V6
From the ecg it's sinus bradycardia and anterolateral ischemia. Holter monitoring. Inj atropine IV SOS. Analgesics. Antiemetic. Cardiology opinion. Need trop I, abg, RBS , usg w/a.
Except Bredycardia no significant conclusion can be derived from ECG. Other systemic involvement like Hepeto billary system and Renal system functioning should be taken in considerations.
S.Bradycardia St t changes in Inf leads & v2 to v6 Need old ecg to confirm changes NEW/OLD Otherwise Echo, Troponin
Sinus bradycardia, inferolateral wall ischemia.cardiac enzymes,2d echo, serial ecg's should be done.
Cases that would interest you
- Login to View the image
45 year old lady presents in ER with history of severe epigastric pain. Her amylase and lipase were wnl. She was advised PPi was advised to follow up in opd. Now her LFT are deranged. What differential should we consider?
Dr. Prashant Ved4 Likes4 Answers - Login to View the image
A 30yrs Old Lactating Mother of 2months Old Neonate presented to my OPD with Severe Pain Abdomen at Epigastric area & Peri-Umbilical areas.. USG Abdomen & Pelvis Report along with CBP.. Post your Treatment ideas & If possible, comment regarding the aetiological factors for this condition in this case..??
Dr. Ratan Benerji Ganta1 Like14 Answers - Login to View the image
F 30 multiparty attended ER with c/o severe pain abdomen on Rt hypochondrium radiating towards mid abdomen mainly upper epigastrium & to the back with shivering (due to cold) with 2 episodes of vomiting.No HTN,No DM. Advice USG abdomen,ECG,CBC, Amylase Lypase,LFT, Treatment NPM,IV fluids 6 hourly,Inj Cefrrixone 1gm BD Inj Amikacin 500mg BD,Inj Pantaprazole 40 mg BD,Inj Tramadol 100mg TDS,Inj Diazepam,Inj Metronidazole 500mg TDS,Inj Onsansetron stat & SOS,Inj Drotavarin 80 mg stat.Interpret ECG,PD & Line of management.Sorry for tracing quality.
Dr. Sanjoy Sarkar2 Likes12 Answers - Login to View the image
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?
Nitin Goje0 Like4 Answers - Login to View the image
26 M sudden abdomen pain, vomiting vitals stable DD and treatment
Dr. Chandra Shekhar1 Like16 Answers
3 Likes