Concluded Case

55M Pain in abdomen x 5 days. No h/o nausea,vomiting,pruritus,clay colored stool hematemesis,melena. Passing stool &flatus. Pulse: feeble B.P :60/30 mmHg

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Concluded answer

There is super massive enlargement of stomach with hemodynamic instability Patient passing flatus and stool This indicates that there is no intestinal obstruction as patient is passing flatus and stool This points to Acute Gastric Dilatation of stomach As differential diagnosis Adv Urgent nasogastric tube insertion with decompression of stomach Resuscitation with IV fluids, Ionotropic support, monitor CVP and urine output Check Hb, CBC, electrolyte and creatinine CT abdomen with contrast once patient stable with aim to look for viability of stomach He may require surgical intervention depending on CT scan abdomen finding

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There is super massive enlargement of stomach with hemodynamic instability Patient passing flatus and stool This indicates that there is no intestinal obstruction as patient is passing flatus and stool This points to Acute Gastric Dilatation of stomach As differential diagnosis Adv Urgent nasogastric tube insertion with decompression of stomach Resuscitation with IV fluids, Ionotropic support, monitor CVP and urine output Check Hb, CBC, electrolyte and creatinine CT abdomen with contrast once patient stable with aim to look for viability of stomach He may require surgical intervention depending on CT scan abdomen finding

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Multiple air fluid levels, suggestive of intestinal obstruction Left sided moderate pleural effusion Eventration of left dome Gross distension of stomach ,? Acute gastric dilatation. . RT aspiration , IV fluids, pressors, antibiotics Abdominal ultrasound , CT abdomen ,

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Lt basal lung abscess dd lt diaphragm hernia bleeding in gi tract do scopy or capsular endoscopy pt hypotensive admit blood transfusion with dopamine drip treat cause

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This is not intestinal obstruction Huge gas shadow lt upper quaderant with fluid level is likely STOMACH pushing diaphragm up in chest ie eventration. Yes it is ACUTE DIALATATION OF STOMACH And immediate ressucitation by deflating stomach Put nasogatric or ryles tube and aspirate gastric contents Balance the electrolytes by iv fluids Monitor vital

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SUGGESTIVE OF DILATED GASTRIC. SHADOWS LT. HEMIDIAPHRAGM. ... ..EVENTRATION POSSIBLY... ILEO - COLIC INTUSSUPTION DD ACUTE. GASTRIC. DILATATION NEEDS INVESTIGATIONS AND IMMEDIATE. MANAGEMENT

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Ac gastric dilatation with fluid level in stomach X ray also reveals Lt diaphragmatic eventration PT need nasogastric tubing to decompress abdomen IV fluid with electrolytes replacement Maintain bp using vasopressors CT abdomen to see etiology of। pathology CBC to assess inf Use BT CONTINUEOS MONITORING OR TAKE OPENION FROM GASTERO ENTEROLOGIST

Left sided minimal pleural effusion seen. Eventration of left hemidiaphragm. Dilated gastric shadows.

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Lt pleural effusion Eventration of Lt diaphragm Gas under diaphragm G I perforation Eventration of Lt diaphragm

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Gas under diaphragm, mild plural effusion Lt side BP low may be peritonitis Urgently surgeon opinion needed

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Ileo colic intussuption

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