Concluded Case

EPIGASTRIC PAIN

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?

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Concluded answer

Severe epigastric pain is most likely due to acid peptic in origin - can be a gastric or duodenal ulcer , duodenitis or acute erosive gastritis. D/D 1 Acute pancreatitis- but unlikely as s.Amylase and lipase are normal 2.Uncommonly acute M.I can present with severe epigastric pain - get an ECG done 3.NAFLD - the L.F.T are only mildly deranged- can be due to fatty liver disease. 4.Acute abdomen - can be due to perforated peptic ulcer , acute appendicitis initially can present with epigastric or umbilical region pain which may later shift to right iliac fossa Investigations needed are 1.An X- ray abdomen standing 2.USG- abdomen 3.An upper G.I endoscopy

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Severe epigastric pain is most likely due to acid peptic in origin - can be a gastric or duodenal ulcer , duodenitis or acute erosive gastritis. D/D 1 Acute pancreatitis- but unlikely as s.Amylase and lipase are normal 2.Uncommonly acute M.I can present with severe epigastric pain - get an ECG done 3.NAFLD - the L.F.T are only mildly deranged- can be due to fatty liver disease. 4.Acute abdomen - can be due to perforated peptic ulcer , acute appendicitis initially can present with epigastric or umbilical region pain which may later shift to right iliac fossa Investigations needed are 1.An X- ray abdomen standing 2.USG- abdomen 3.An upper G.I endoscopy

There are many causes of deranged live enzymes A Cholecysyitis with or without cholelithiasis B. Viral hepatitis C. Acoholic hepatitis D. Induced hepatitis due to medicine sold over the counter like Paracetamol E. Many prescribed medicine like staying group USG Abdomen will help

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VIRAL HEPATITIS IS A POSSIBLE DIAGNOSIS --------------------------------- ALT & AST = RAISED DISPROPORTIONATELY THAN ALP ------------------------------------------ HER EPIGASTRIC PAIN IS DUE TO STRETCHING OF LIVER CAPSULE DUE TO HEPATIC ENLARGEMENT & HEPATITIS

R/o Acute Cholecystitis/Cholelithiasis

non-alcoholic steatohepatitis (NASH) and chronic viral hepatitis are common causes associated with raised ALT and AST. Also rule out Hypothyroidism and recent MI. Advise Usg abdomen, ggt(if alcoholic), cbc, esr. If it cant be rectified after the aforementioned tests, go for Upper GI endo

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