Ebook 100 Cases in emergency medicine and critical care: Part 2
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Ebook 100 Cases in emergency medicine and critical care: Part 2
https://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2of worsening upper abdominal pain that radiates to his back. He has vomited twice. He denies any bowel or urinary symptoms. This is the first time the pain has lasted this long; usually it resolves within 2 hours. His comorbidities include diabetes milletus and hypertension. He smokes 30 cigarettes Ebook 100 Cases in emergency medicine and critical care: Part 2per day and 40 units of alcohol per week.ExaminationVital signs: temperature of 33.7°c, heart rate of 108, blood pressure of 154/78, respiratory rateEbook 100 Cases in emergency medicine and critical care: Part 2
of 22,96% saturation on room air. He has guarding in the right upper quadrant, but the abdomen is soft. Deep palpation on inspiration arrests his breahttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2you manage him?199100 Cases in Emergency Medicine and Critical CareDISCUSSIONThis patient has acute cholecystitis. He has a probable history of gallstones and is now febrile and Murphy’s sign positive on examination.Most patients with gallstones are asymptomatic. However, complications of gallstones Ebook 100 Cases in emergency medicine and critical care: Part 2 range from biliary colic, whereby gallstones irritate or temporarily block the biliary tract, to acute cholecystitis, which is an infection of the gaEbook 100 Cases in emergency medicine and critical care: Part 2
llbladder sometimes due to obstruction of the cystic duct. Gallstones can also become trapped in the common bile duct (choledocholithia-sis) causing jhttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2triad of fever, right upper quadrant (RUQ) pain and jaundice. It can be life-threatening.The majority of gallstones contain cholesterol but some contain pigment. Risk factors include pregnancy, elderly, obesity, haemolytic blood conditions (e.g. sickle cell disease, hereditary elliptocytosis) and ce Ebook 100 Cases in emergency medicine and critical care: Part 2rtain ethnic groups (Hispanics, northern Europeans).Biliary colic typically presents with wave-like RƯQ or epigastric pain radiating to the back and iEbook 100 Cases in emergency medicine and critical care: Part 2
s associated with nausea that starts after a heavy or fatty meal or at night. The patient moves around to get comfortable, as opposed to a peritonitichttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2s usually associated with fever.Murphy’s sign is a sensitive examination sign for acute cholecystitis. Place your hand below the right costal margin in the RƯQ and ask the patient to deeply inspire. If the gallbladder is inflamed, the patient will ‘catch their breath’ and experience pain.Patients wi Ebook 100 Cases in emergency medicine and critical care: Part 2th epigastric or RUQ pain require a full blood count, renal and electrolyte screening, liver function tests (LFT), serum calcium and amylase/lipase leEbook 100 Cases in emergency medicine and critical care: Part 2
vel to rule out pancreatitis. In women of child-bearing age, a pregnancy test and urinalysis are vital. In biliary colic, the blood tests are usually https://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2re of acute cholecystitis. Its presence should raise suspicion for choledocholithiasis or Mirizzi syndrome whereby a gallstone in Hartmann s pouch or the cystic duct causes external compression of the bile duct.The first-line investigation of choice for biliary colic or cholecystitis is ultrasonagra Ebook 100 Cases in emergency medicine and critical care: Part 2phy. Ihis is quick and non-radiative (useful in children and pregnancy), and has a sensitivity of over 90%. It can also evaluate other causes of abdomEbook 100 Cases in emergency medicine and critical care: Part 2
inal pain including the pancreas, liver, aorta and kidneys, lhe common features in cholecystitis are gallbladder wall thickening, distention and perichttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2o bile, and so may provide false negative results.Biliary colic requires supportive therapy in the form of adequate analgesia and anti-emetics, but does not require antibiotics. The patient should be counseled on dietary modification (avoiding fatty food and heavy meals). The patient should be refer Ebook 100 Cases in emergency medicine and critical care: Part 2red to a general surgeon on an outpatient basis for consideration of a laparoscopic cholecystectomy.Acute cholecytitis requires antibiotic therapy andEbook 100 Cases in emergency medicine and critical care: Part 2
admission under general surgery, who should decide whether to perform a ‘hot’ emergency cholecystectomy within 24-72 hours of admission. This shortenhttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history o Ebook 100 Cases in emergency medicine and critical care: Part 2complications including a perforated gallbladder causing peritonism or an empyema. Most patients will undergo an elective laparoscopic cholecystectomy once the inflammation has resolved.Acute cholecystitis is associated with RUQ pain (>6 hours), fever and a positive Murphy's sign on examination.Ultr Ebook 100 Cases in emergency medicine and critical care: Part 2asonography of the abdomen and pelvis is the first-line investigation for gallstone disease.Management of acute cholecystitis includes antibiotics, flEbook 100 Cases in emergency medicine and critical care: Part 2
uids and dietary modification.201KHCTaylor &. FrancisTaylor &. Francis Grouphttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history ohttps://khothuvien.cori!GENERAL SURGERY AND UROLOGYCASE 57: UPPER ABDOMINAL PAINHistoryA 43-year-old overweight male presents with an 8-hour history oGọi ngay
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