A male patient of age 54 came with the chief complaints of abdominal pain which is sudden in onset and is of acute type. Distended abdomen. The person is known alcoholic and smoker. No history of fever, vomitings or abdominal tenderness. No flatus being passed. What is the probable diagnosis?

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?

The Differential Diagnosis Of Appendicitis Is Often Challenging- Why? The overall accuracy for diagnosing acute appendicitis is approximately 80%, corresponding to a mean negative appendectomy rate of 20%. Diagnostic accuracy varies by sex, with a range of 78-92% in male patients and 58-85% in female patients. The classic history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain, and vomiting occurs in only 50% of cases. Vomiting that precedes pain is suggestive of intestinal obstruction, and the diagnosis of appendicitis should be reconsidered. The differential diagnosis of appendicitis is often a clinical challenge because appendicitis can mimic several abdominal conditions. Patients with many other disorders present with symptoms similar to those of appendicitis, such as the following: Surgical Intestinal obstruction Intussusception Acute cholecystitis Perforated peptic ulcer Mesenteric adenitis Meckel's diverticulitis Colonic/appendicular diverticulitis Pancreatitis Rectus sheath haematoma Urological Right ureteric colic Right pyelonephritis Urinary tract infection Gynecological Ectopic pregnancy Ruptured ovarian follicle Torted ovarian cyst Salpingitis/pelvic inflammatory disease Medical Gastroenteritis Pneumonia Terminal ileitis Diabetic ketoacidosis Preherpetic pain on the right 10th and 11th dorsal nerves Porphyria Misdiagnosis in women of childbearing age Appendicitis is misdiagnosed in 33% of nonpregnant women of childbearing age. The most frequent misdiagnoses are pelvic inflammatory disease (PID), followed by gastroenteritis and urinary tract infection. In distinguishing appendiceal pain from that of PID, anorexia, and onset of pain more than 14 days after menses suggests appendicitis. Previous PID, vaginal discharge, or urinary symptoms indicate PID. On physical examination, tenderness outside the RLQ, cervical motion tenderness, vaginal discharge, and positive urinalysis support the diagnosis of PID. Although negative appendectomy does not appear to adversely affect maternal or fetal health, diagnostic delay with perforation does increase fetal and maternal morbidity. Therefore, an aggressive evaluation of the appendix is warranted in pregnant women. The level of urinary beta-human chorionic gonadotropin (beta-hCG) is useful in differentiating appendicitis from an early ectopic pregnancy. However, with regard to the WBC count, physiologic leukocytosis during pregnancy makes this study less useful in the diagnosis than at other times, and no reliable distinguishing WBC parameters are cited in the literature. Also, Read  COVID-19 Differential Diagnosis    

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?

A 24-year-old man is bought in from a night club intoxicated, vomiting and complaining of severe upper abdominal and retrostemal chest pain. He had been on a stag night and had been drinking all day. He started vomiting 2 hours after a curry and the pain commenced acutely shortly afterwards. His friends called an ambulance 2 hours later as he was in too much pain to continue the bar crawl, On examination, his pulse was 130 bpm, his respiratory rate was 30 bpm and his blood pressure 90/60 mmHg. What is the diagnosis ? A) Acute Cholecystitis B) Acute pancreatitis C) Boerhaave's Syndrome D) Perforated peptic ulcer E) Ruptured aortic aneurysm