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Abdo Pain & Syncope

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History of Present Illness:

A 52-year-old female presents to the ED for 36 hours of epigastric pain that today became generalized.  She felt nauseous so she tried to vomit and had a syncopal episode. She felt like she was going to get diarrhea but had a normal bowel movement yesterday without blood. She has had intermittent epigastric pain over the years which she has taken omeprazole and she takes daily Advil for chronic back pain. There has been no melena or hematemesis fever or chills or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal but her BP in the field was 80/40.  Physical exam is otherwise normal except for diffuse abdominal tenderness with slight guarding

Initial Differential Diagnosis:

  • Gastritis
  • Vasovagal
  • ACS
  • SBO

Initial Diagnostic Testing:

  • EKG: NAD
  • Labs: Normal except for troponin of 0.11
  • Imaging: See cut from CT below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows blood surrounding the liver
  2. What should you do next?  Consult general surgery and interventional radiology
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: Patient was admitted and hemoglobin dropped from about 12.5 to around 8.5 but eventually stabilized.  Her vitals remained stable.  CT angio and tagged RBC scans were negative for additional bleeding.  The source of bleeding was never determined.

CASE LESSONS:

  1. Always consider vascular conditions with abdominal pain and syncope
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