Main menu:

Google


Epigastric Pain

UNFINISHED CASE: COME BACK LATER 

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

History of Present Illness:

  • A 65-year-old male with DM and HTN presents to the ED with acute onset of epigastric pain at 5 AM associated with chills and nausea.
  • He denies fever or shortness of breath, vomiting, diarrhea, dysuria or flank pain.
  • He does not volunteer it, but when asked does admit to some discomfort in the area of the right scapula

Vital Signs & Physical Exam:

  • Vital signs are normal.
  • Physical exam is normal except for epigastric tenderness

Initial Differential Diagnosis:

  • Gastritis
  • Gallstones
  • ACS
  • Pancreatitis

Initial Diagnostic Testing:

  • CBC, LFTs and BMP are normal except for a glucose of 177
  • The ultrasound is shown below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Where can one get a quick refresher on this topic?  

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>

***************************************************************************

THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA

Tarascan Emergency Department Quick Reference GuideA to Z 3rd ed book cover

Get one of our publications, all designed specifically for Emergency Care Providers:

***************************************************************************

<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>

ANSWERS:

  1. What does the case image image show?  The image shows a wall echo sign, which is a gallbladder completely filled with stones so that you can only see the anterior wall.  Everything far field of that is in shadow
  2. What should you do next?  Pain medicine and consult  surgery .   See case conclusion below tutorial page-shot.
  3. Where can one get a quick refresher on this topic?  See yellow highlighted area below from purple book above…  KEY POINT: in the ED cholecystitis is more common than biliary colic.  If the pain is lasting for >6 hours don’t be reassured by normal gallbladder wall thickness and normal labs.  They are not sensitive enough.  Either get a DESIDA scan, admit the patient or arrange for next day follow-up.  Do not send home on opiates.

1-Minute Consult on the EM topic for this case from the Tarascon Emergency Department Quick Reference Guide

 

CLICK HERE TO SEE OUR BOOKS

CASE CONCLUSION: A DESIDA scan was positive for cholecystitis.  The patient was admitted for antibiotics and taken to the OR within 6 hours of admission.

:
Google
 
Web www.edinsight.com