A male pt aged 44 years p/w complaints of Pain Abdomen and Vomitings (Multiple) since 2 days... He also had 1 episode of Fever and severe constipation... comment on his Xray and discuss the causes of his symptoms
Right dome of diaphragm is raised and ground glass appearance in one of the X- Rays. Do a clinical abdominal examination to look for 1.Tenderness right hypochondrium for acute cholecystitis, right iliac fossa for acute appendicitis and epigastric tenderness for acute pancreatitis. 2.Diffuse tenderness all over abdomen which can be seen in acute hemorrhagic pancreatitis and Peritonitis. 3.Palpate for any hard masses in left iliac fossa,which can be faecoliths causing subacute intestinal obstruction. An Ultrasound abdomen is the next most important diagnostic tool to confirm your clinical findings. A Digital rectal examination can be helpful to looks for fecoliths . Meanwhile start with conservative treatment 1 NPO 2 RT suction 3.IV fluids 4.Parenteral antibiotics 5.inj Pantoprazole and Emeset
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