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F 30 multiparty attended ER with c/o severe pain abdomen on Rt hypochondrium radiating towards mid abdomen mainly upper epigastrium & to the back with shivering (due to cold) with 2 episodes of vomiting.No HTN,No DM. Advice USG abdomen,ECG,CBC, Amylase Lypase,LFT, Treatment NPM,IV fluids 6 hourly,Inj Cefrrixone 1gm BD Inj Amikacin 500mg BD,Inj Pantaprazole 40 mg BD,Inj Tramadol 100mg TDS,Inj Diazepam,Inj Metronidazole 500mg TDS,Inj Onsansetron stat & SOS,Inj Drotavarin 80 mg stat.Interpret ECG,PD & Line of management.Sorry for tracing quality.

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Concluded answer

Already concluded. Previous case of a cute cholecystitis with cholelithiasis.

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NEED HISTORY CLINICAL EXAM 1 PAIN GRADUALLY RISING TO PEAK = PANCREATITIS 2 CONSTATANT PAIN = CHOLELITHIASIS 3 DECUBITUS SITTING , BENDING FORWARD = CHOLELITHIASIS 4 MURPHY'S SIGN + G B DISEASE 5 MUSCLE GUARD UPPER ABD PEPTIC PERFORATION G B DISEASE 6 RELATIVELY LESS FINDING IN ACUTE PANCREATITIS 7 LIVER DULLNESS OBLITERATED PEPTIC PERFORATION LEUKOCYTOSIS = CHOLECYSTITIS & CHOLELITHEASIS PANCREATITIS BLOOD AMYLASE LIPASE Ca ++ Na+.K +@ Hco- USG ABD CT SCAN ABD .UGI ENDOSCOPY VOMITING = FLUID LOSS THERE CAN BE METABOLIC .. ALKALOSIS IV FLUID IF REQUIRED= NORMAL SALINE RELIEF OF PAIN = INJ TRAMAZAC 100 M g IM / IV RELIEF OF VOMITING = INJ ONDESTERONE IF THERE IS EVIDENCE TO SUSPECT PANCREATITIS / GB DISEASE IV ANTIBIOTIC CEFTRIXONE - TAZOBACTEM NOTHING ORALLY / OTHERWISE SMALL AMOUNT ORS MAY BE GIVEN IF NO VOMITING OR PAIN ABDOMEN TREATMENT WILL DEPEND UPON CLINICAL AND LAB DIAGNOSIS CONDITION OF THE PT ALL PTS CAN NOT PUT IN ONE DICE

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Sir, liver dysfunction along with pain and abnormal ECG, I agree with Dr Dinesh Sir but IVF should be monitored in accordance with ABG/VBG reports as possibility of electrolyte imbalance has to be ruled out. Forgive me for my mistakes and guide me further. Thank you

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Most probably dx is acute cholecystitis with cholelithiasis.Ecg shows non specific Twave invesion may be post meal.Cbc usg of whole abdomen most likely clinch the diagnosis.

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T wave inversion in v1 to v4 Persistent juvenile pattern St depression in inf leads r found many times due to Upper abdominal pathology (like Hepatitis, pancreatitis, biliary pain)

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Nonspecific T inversion in multiple leads otherwise twnl ,might suffering from renal colic ,but you are not mentioning any rigidity anywhere ,certainly will see the relevant reports

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Now Patient is stable, asymptomatic.Reports all pending.

As. per. the. REPORTS .. ADVISABLE.... 1 ). L F T.....R F T 2 ). U S G........ CHEST...and. Whole. Abdomen... Including... K U B. Region.. 3 ). Electrolytes. and. Proteins.. ABG. and. VBG... MANAGEMENT.. . Accordingly...

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Already concluded. Previous case of a cute cholecystitis with cholelithiasis.

Ecg normal, usg abdomen necessary, may be pancreatitis or intestinal, more chances of pancreatitis

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ECG- NAD

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