Severe abdominal pain

Chief Complaint A 52-year-old male was taken to the hospital with a complaint of severe abdominal pain and fever since yesterday. History Yesterday e fell unconscious at home and had back pain immediately after that. Vitals Temp: 101.2 degree F, BP: 135/85 mmhg, Pulse: 103 bpm, RR: 50 bpm, the patient had a mild temperature elevation and abdominal rigidity on exam Investigations WBC: 10,950/µL (4,500-11,000/µL) with a bandemia of 19% and thrombocytopenia of 113,000/µL (130,000-400,000/µL). Serum creatine kinase level was 103,105 U/L (<230 U/L). ALT of 345 U/L (<46 U/L). CT Head normal, In CT of the abdomen and pelvis we noted mildly dilated transverse colon. Treatment What is your opinion on diagnosis and treatment?

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Pt having acute pain abdomen with rise of temperature with abdominal rigidity indicates acute abdomen suggested also by abdominal rigidity, causes if acute abdomen A. Perforation of hollow viscous. B. Acute cholecystitis with severe infection C Acute Pancreatitis. All acute condition with severe infection there is reactionary peritonitis giving rise to rigidity of abdomen with paralytic ileus giving rise of dilated intestine either small or large intestine with sluggish bowel sound. Xray in erect posture to exclude any gas under diaphragm to rule out perforation. Blood for pancreatic enzyme serum amylase and lipase USG to see gall bladder pathology or for pin point of perforation. Liver function test Kidney function and elctrolytes ECG. to see any myocarditis due to heart ailment as serum creatinine kinase label is on higher side. NPM Ryle' s tube suction Antibiotic Inj Momocef 1 gm + Salbactum ,500 mg Iv bd Inj Raviprazole IV to be given Watch for vitals Intake out put chart After all investigation to decide for next step of treatment.

Thanks Dr Ramesh C Yadav

*ACUTE Abdomen Abdominal rigidity. Fever. Leucocytosis Inflammation is there. Needs further investigation and evaluation to conclude till reports complied Nothing by mouth or RT suction Iv fluids to maintain infusion line for antibiotics,metrogyl and Multivitamin. Inj diclo+ PCM I'm stat than SOS for pain. Iv fluids and maintain electrolytes balance.

Thanks Dr Dinesh Gupta

Acute abdomen most likely peritonitis considering abdominal rigidity which indicates,inflammation of parietal peritoneum besides visceral peritoneum . Get an X- ray abdomen standing including domes of diaphragm for gas under right dome of diaphragm. An ultrasound abdomen to locate the site of organ involved . Meanwhile start with conservative treatment NPO RT suction IV fluids Parenteral antibiotics

Acute gangrenous cholecystitis with perforation and peritonitis . But CT abdomen has been reported as normal. Is CK is One lakh and three thousand one hundred and five ?? Typo If it is right it can point to acue muscle necrosis ,? Statin use, myositis, myoglobinemia,



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