A 39-year-old woman is admitted to you because of severe abdominal pain and vomiting. She states that her illness began about 3 days ago with midepigastric pain and nausea, and progressed to severe abdominal pain, nausea and vomiting. She describes her pain as crampy, without any radiation, and continuous throughout the day so that she cannot eat. She denies back pain, flank pain, diarrhea, dysuria, hematuria, cough or any similar episode of pain before. She denies eating any unusual foods, and her medications include NSAIDs for headaches, and oral contraceptives; she recently took a course of metronidazole for Trichomonas vaginitis. She is employed as a corporate vice-president, and lives with her daughter and husband. She does not smoke cigarettes and drinks alcohol only on social occasions. Her parents both died of cancer and she had a sister who committed suicide. PE reveals a thin woman lying on her side in a fetal position. T 99, P 130, R 20, BP 100/82. SKIN - warm, dry without lesions. LN - none. HEENT - normal with dry mucosa. CHEST - clear. HEART - RRR 2/6 SEM; no rub or gallop. ABD - scaphoid with diffuse tenderness to light palpation especially in midepigastrium; voluntary guarding in all quadrants; no rebound; no organomegaly or palpable masses; BS absent. PELVIC - normal with normal rectum. Stool trace heme positive. NEURO - nonfocal. LABS Na 142, K 3.1, Cl 100, HCO3 36, BUN 25 Cr 1.2, glu 60 Hb 13.3, Hct 39.7, WBC 14.8 (88 segs, 10 bands, 2 lymphs) UA – normal; ABG (RA) 7.50/38/64 AST 102; ALT 75; Alk Phos 126; LDH 140 Amylase 806; Lipase 180 EKG – Sinus tach 130/flattened T waves in V2-V6 CXR - atelectasis at both bases; small left pleural effusion What is the differential diagnosis of this patient's abdominal pain and how will you manage the case ?
Interesting case Differntials are Acute pancreatitis with SIRS and effusion Perforated peptic ulcer with peritonitis NSAID enteropathy As here amylase and lipase are high, Treat as pancreatitis episode.. Keep NPO at present till pain subsides... IV fluids with aggresive resucitation, Analgesics... Once stable after 24 hour if creat and urine output is all right, do CECt abdomen and OGD scopy for confirmation of diagnosis
D/d peptic ulcer probably DU as per her posture and stool is positive for malena 2 r/o parapancreatic lyphadenopathy 3 Chest xray shows atelactesis with lt pleural effusion needs hrct to r/o malignancy 4 lady takes alcohol lfts and usg abd to r/o liver pathology. So far Rx is concerned nothing specific till final dx reached treat symptomatically iv fluids antispasmodics like tromodol with antiemetics and infuse pantaprazole in iv fluid support of antibiotics. Ecg is significant and needs attention repeat and do 2decho and cardiac enzymes
Acute Gastritis Sporolac tds Ocid 2 mg od in morning Gelusil MPS 1tsf tds Meftal spas for pain sos. Avoid spicy oily and fast food. Maintain nutrition hydration and hygiene.
Drug induced Gestritis..
DD: . Acute pancreatitis . NSAID induced gastric ulcer
ACUTE.... .... GASTRITIS ..... PANCREATITIS .... DRUG. INDUCED..
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