pt of RHD not on warfarin ...presented with abdominal pain with brownish discoloration over abdominal wall ..since 6 days with abdominal tenderness ...jvp was raise and b/L pedal oedema ..on routine INR was 1.7, platelets 50000,wbc -14700, bilirubin 6 ,with sgot and sgpt was 100 and 300 ,kindly comment ....

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Kco RHF p/w leucocytosis and thrombocytopenia and deranged lfts Jvp is raised pedal oedema All indicates pt is in coagulation disorder Thrombocytopenia leading to hemorrhage intra abdominal as well as percutaneous may be purpura due to liver dysfunction as a result of jaundice and portal hypertension as raised jvp is suggesting 2 r/o d i c

Thanx dr Sumit Kumar Vishwakarma
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A case of CCF with acute haemorrhagic pancreatitis with Cullen 's sign. Needs a treatment in ICU - Get an ultrasound scan abdomen done to confirm the diagnosis. Also get s.Amylase, s.calcium levels done . IV fluids, inj Dytor , RT Suction, NPO, parenteral antibiotics and if indicated platelet transfusions

Serum amylase was normal sir...and usg not suggesting of pancreatitis....
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Ecchymosis over abdominal wall 1) Alcoholic cirrhosis with portal hypertension and hepatocelluar failure 2) Budd chiary syndrome, (hepatic venous thrombosis ) 3) Cullen's sign due to pancreatitis or retroperitoneal bleeding 4) RHD, cardiac failure , on aspirin, clopidogrel

Is he ALCOHOLIC? SUBCUTANEOUS HEMATOMA HEMOLYTIC JAUNDICE? WITH THROMBOCYTOPENIA?? Go for HEMATOLOGIST OPINION... ITS LOOKING LIKE SOME BLOOD COAGULATION DISORDER Cullen's sign positive. Go for PANCREATIC PROFILE DO USG OR CT ABDOMEN DO CARDIAC PROFILE, ECG, 2DECHO XRAY. TO R/O RHD/ CCF/ LVH ETC IF FEBRILE, DO DENGUE NS1, AG AB U CAN THINK OF THIAMINE AND VIT K AS A SUPPORTIVE RX WITH WHATEVER TREATMENT GOING

Which fraction of bilirubin is more raised, alkaline phosphatase, USG abdomen to look for any biliary obstruction/pancreatitis, 2D Echo to look for right sided heart failure and NT pro BNP R/O cardiac cirrhosis

Patient is in CHF. Ad- usg abdomen pelvis for hepatomegaly. Coagulation defect/clotting factors deficiency ? 2DEcho for extent of valvular pathology. H/o fever? Dengue. NS 1

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

IT'S A CASE OF. ECCHYMOSIS ON ABDOMINAL WALL ALCOHOLIC HE PATO PATHOLOGY.. CULLEN'S SIGN .. RHD .. NEED'S CLINICOPATHOLOGICAL EVALUATION FOR CONFIRMATION AND MANAGEMENT..

Tnx Dr Mujmal Shaikh
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POSSIBLY CHF.. WITH... ACUTE. HEMORRHAGIC PANCREATITIS... ... CULLEN'S. SIGN ADVISABLE.... USG..... ABDOMEN

Agree with Dr.Praveen Yograj Yes this sign is Cullen’s sign

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