Concluded Case

Acute abdominal pain

All thing provide Investigations INVESTIGATIONS Haemoglobin White cell count Platelets Sodium Potassium Urea Creatinine Bilirubin Alkaline phosphatase Alanine aminotransferase (AAT) Gamma-glutamyl transpeptidase C-reactive protein (CRP) 14.7 g/dL 19.8 109/L 239 109/L 137 mmol/L 4.8 mmol/L 8.6 mmol/L 116 mol/L 19 mol/L 58 IU/L 67 IU/L 72 IU/L 256 mg/L Normal 11.7–15.7 g/dL 3.5–11.0 109/L 150–440 109/L 135–145 mmol/L 3.5–5.0 mmol/L 2.5–6.7 mmol/L 70–120 mol/L 3–17 mol/L 30–300 IU/L 5–35 IU/L 11–51 IU/L 5 mg/L What is the diagnosis? How would u manage this patient Physical Examination The patient looks unwell and dehydrated. She weighs 115 kg. She is febrile, 38.5°C, her pulse is 108/min and blood pressure 124/76 mmHg. Cardiovascular and respiratory system examination is normal. She is tender in the right upper quadrant and epigastrium, with guarding and rebound tenderness. Bowel sounds are sparse. History A 56-year-old woman presents to the emergency department 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. Her past medical history is notable for a duodenal ulcer which was successfully treated with Helicobacter eradication therapy 5 years earlier. She smokes 15 cigarettes a day, and shares a bottle of wine each evening with her husband.

2 Likes

LikeAnswersShare
Concluded answer

D/D Acute cholecystitis Acute pancreatitis Acid peptic disease, may be leading to perforation

All Answers

As per the history suggest and past history of of duodenal ulcer. Most probable causes are A. Acute exacervation of peptic ulcer B peptic perforation C acute cholecystitis or acute on chronic cholecystitis D. Acute pancreatitis As the pain radiates to back may be due to pacreatitis but in cholecystitis also pai radiates. Blood reports you posted very difficult to understand better next time you post the photo copy of the report sheet Urgent investigation Str xaray abdomen in erect posture USG/ CT scan to get better idea of pancreatitis and gall bladder pathology Blood for serum amylase and lipase NPM IV DRIP TO CONTINUE WITH 5% dextrose and ringer lactate Antibiotic higher antibiotic Inj PPI one vial iv bd Ryles tube suction Further to be decided after getting the investigation report.

Thank you doctor
0

View 1 other reply

Past h/o duodenal ulcer .. could have flared up.. to start on Ppi infusion ... With weight of 113 kgs, and typical severe epigastric pain, could be acute pancreatitis To send amylase , lipase Since upper quadrant pain is also there, to r/o cholelithiasis or cholecystitis To get an usg abdomen/ CT abdomen done...

Thank you doctor
2

NBM IV FLUIDS IV ANTIBIOTIC IV ANTISPASMODIC AND ANALGESICS I/O CHART PTR 6 HOURLY I CAN'T UNDERSTAND INVESGATION REPORTS SENT BY YOU Next you can use camera to click investigation slip Go for urgent flat plate abdomen and usg Most probable diagnosis is Cholecystitis with cholelithiasis 2nd peptic ulcer leak Further treatment according to test reports

Thank you doctor
0

POSSIBLE A P. D AC. PANCREATITIS NEEDS . MANAGEMENT. AS. PER INVESTIGATION. REPORTS

D/D Acute cholecystitis Acute pancreatitis Acid peptic disease, may be leading to perforation

Thank you doctor
2

Cases that would interest you