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.
Already concluded. Previous case of a cute cholecystitis with cholelithiasis.
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
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
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.
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)
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
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...
Already concluded. Previous case of a cute cholecystitis with cholelithiasis.
Ecg normal, usg abdomen necessary, may be pancreatitis or intestinal, more chances of pancreatitis
Cases that would interest you
- Login to View the image
A male pt aged 45 years with past history of drinking alcojol and kindney stones., now complains of pain in the rt hypochondriac area and back.......usg normal except hepatic steatosis grade 2.....pt complai s of sever pain in ghat area . No fever Lab reports are wnl. Both direct and indirect bilirubin are on higher end (1.4 and 1.0 )respectively. KFT normal please know how to manage tgis case .@Dr. Sepuri Krishna Mohan
Dr. Mahendra Kumar3 Likes17 Answers - Login to View the image
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?
Dr. Prashant Ved4 Likes4 Answers - Login to View the image
C/o A 56-year-old woman 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. H/o duodenal ulcer which was successfully treated with Helicobacter eradication therapy 5 years earlier. on Examination... The patient looks unwell and dehydrated. She weighs 115 kg. She is febrile, 38.5°C, pulse is 108/min and blood pressure 124/76 mmHg. She is tender in the right upper quadrant and epigastrium, with guarding and rebound tenderness. Bowel sounds are sparse. What is the most likely diagnosis?
Nitin Goje0 Like4 Answers - Login to View the image
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?
Dr. Nelson Jd2 Likes18 Answers - Login to View the image
A 35 Y/F CAME TO ED WITH SEVERE PAIN IN ABDOMEN (RT. HYPOCHONDRIAC REGION ),,1-2 BOUTS OF VOMOTTING AND UNESAYNESS, ,,NO HTN /dm/BA /IHD, ,NO H/O --ANY MAJOR ILLNESS, ,O/E --T-;:99'F, ,B. P --110/70 MM OF HG, ,HR -106 /MIN, ,SPO2 --98 PERCENT AT ROOM AIR, ,,,P/A --SOFT TO PALPATE, ,FINGER TENDER NESS AT RT. HYPOCHONDRIAC REGION, ,NO GUARDING, ,NO RIGIDITY, ,,UO --NORMAL, ,,BELOW R THE VALUES AND IMPRESSION OF BLOOD INVESTIGATION AND USG (A &P ),,SO DEAR FRENDS AND GENTLEMEN PLZZ HELP IN DX AND MX, ,,,REGARDS; ;DR RAJ PANDEY MISHRA
Dr. Raj Pandey Mishra7 Likes25 Answers
2 Likes