Case 4: Gastrointestinal system An 83-year-old man is brought to the emergency room with acute abdominal pain. He has had intermittent episodes of burning/gnawing epigastric pain a few times a year, lasting three to four weeks at a time. The pain usually begins one to two hours after eating and is often relieved by eating. Three hours prior to the patient's evaluation in the ED, he reported an abrupt increase in sharp diffuse abdominal pain and nausea. He subsequently passed out at home and was found by family member. He has been self-treating with antacids and bland diets. The patient underwent an upper gastrointestinal endoscopy one year earlier which demonstrated a 7mm ulcer in the duodenal bulb and moderate antral gastritis. Antral biopsy at the time showed active chronic gastric due to Helicobacter pylori. He takes aspirin for osteoarthritis. Over the last month the patient has also been taking ibuprofen for joint pain relief. He smokes a pack of cigarettes per day and drink 5-6 beers per day. On examination, his blood pressure is 92/63, heart rate 135, respiratory rate 34. He is pale, diaphoretic, and quite uncomfortable. Bowel sounds are absent and the abdomen is distended on inspection; increased abdominal tympany is noted diffusely on percussion. Hepatic dullness is absent. The abdomen is diffusely tender and rigid; rebound tenderness is present. The patient is lying still on the bed as movement seems to worsen his abdominal pain. Initial Laboratory Studies WBC-18,600 (4,000-11,000) Hemoglobin - 16.8 gm/DI (13-16.5) Amylase - 520 U/L (20-60) Flat & upright abdominal X-rays: evidence of scattered small bowel air-fluid levels, free air below the right hemidiaphragm.
Case 4: Gastrointestinal system An 83-year-old man is brought to the emergency room with acute abdominal pain. He has had intermittent episodes of burning/gnawing epigastric pain a few times a year, lasting three to four weeks at a time. The pain usually begins one to two hours after eating and is often relieved by eating. Three hours prior to the patient's evaluation in the ED, he reported an abrupt increase in sharp diffuse abdominal pain and nausea. He subsequently passed out at home and was found by family member. He has been self-treating with antacids and bland diets. The patient underwent an upper gastrointestinal endoscopy one year earlier which demonstrated a 7mm ulcer in the duodenal bulb and moderate antral gastritis. Antral biopsy at the time showed active chronic gastric due to Helicobacter pylori. He takes aspirin for osteoarthritis. Over the last month the patient has also been taking ibuprofen for joint pain relief. He smokes a pack of cigarettes per day and drink 5-6 beers per day. On examination, his blood pressure is 92/63, heart rate 135, respiratory rate 34. He is pale, diaphoretic, and quite uncomfortable. Bowel sounds are absent and the abdomen is distended on inspection; increased abdominal tympany is noted diffusely on percussion. Hepatic dullness is absent. The abdomen is diffusely tender and rigid; rebound tenderness is present. The patient is lying still on the bed as movement seems to worsen his abdominal pain. Initial Laboratory Studies WBC-18,600 (4,000-11,000) Hemoglobin - 16.8 gm/DI (13-16.5) Amylase - 520 U/L (20-60) Flat & upright abdominal X-rays: evidence of scattered small bowel air-fluid levels, free air below the right hemidiaphragm.
Chapter17: Drugs And Dissection
Section: Chapter Questions
Problem 1CP
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Transcribed Image Text:1. At the end of the session, students should be able to take a relevant history.
2. Identify the various abdominal quadrants and structures causing pain.
4. What is the probable diagnosis? Interpret the X-ray findings and know what
Transcribed Image Text:Case 4: Gastrointestinal system
An 83-year-old man is brought to the emergency room with acute abdominal
pain. He has had intermittent episodes of burning/gnawing epigastric pain a few
times a year, lasting three to four weeks at a time. The pain usually begins one to
two hours after eating and is often relieved by eating. Three hours prior to the
patient's evaluation in the ED, he reported an abrupt increase in sharp diffuse
abdominal pain and nausea. He subsequently passed out at home and was found
by family member.
He has been self-treating with antacids and bland diets. The patient underwent an
upper gastrointestinal endoscopy one year earlier which demonstrated a 7mm
ulcer in the duodenal bulb and moderate antral gastritis. Antral biopsy at the time
showed active chr gastric to Helicobacter pylori.
He takes aspirin for osteoarthritis. Over the last month the patient has also been
taking ibuprofen for joint pain relief. He smokes a pack of cigarettes per day and
drink 5-6 beers per day.
On examination, his blood pressure is 92/63, heart rate 135, respiratory rate 34.
He is pale, diaphoretic, and quite uncomfortable. Bowel sounds are absent and
the abdomen is distended on inspection; increased abdominal tympany is noted
diffusely on percussion. Hepatic dullness is absent. The abdomen is diffusely
tender and rigid; rebound tenderness is present. The patient is lying still on the
bed as movement seems to worsen his abdominal pain.
Initial Laboratory Studies
WBC - 18,600 (4,000-11,000)
Hemoglobin - 16.8 gm/DI (13-16.5)
Amylase - 520 U/L (20-60)
Flat & upright abdominal X-rays: evidence of scattered small bowel air-fluid levels,
free air below the right hemidiaphragm.
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