General

Case Study - monday 12092016

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12 Sep 2016 - General
 

A middle aged gentleman, with background history increased body mass index, hypertension, type 2 diabetes, smoker, oestoarthritis, presented to casualty due to severe epigastric pain with few episodes of vomiting in the afternoon. Patient was very unwell when attending casualty, and was seem to be in severe abdominal pain. Patient was not drinking any alcohol for the last week, and deny any haematemesis. On examiantion showed patient has severe upper abdominal pain.He had low blood pressure of 85/65, arterial blood gas show acidosis (pH 7.21), high lactate of 5. Fulll blood count showed that his Haemoglobullin (Hb) was around 11.0. Normal amylase level. Cardiac investigation (ECG, troponin) was negative. What is your differential diagnosi ? What is your managment plan ? 

There are several surgical approaches to the treatment of a perforated ulcer. The choice of the operative procedure generally depends of the patient’s medical condition, hemodynamic instability, comorbid conditions, estimated size of perforation, duration of symptoms, past history of chronic or recurrent ulceration. For patients who have multiple comorbid conditions with hemodynamic instability, the safest procedure will be simple closure with Graham patching. This is the safest because it is a ...
 (Total 120 words)
Yes, rupture abdominal aorta aneurysm is definitely an important differential diagnosis to rule out. It seems like this patient was having an acute surgical abdomen. Apart from rupture abdominal aorta aneurysm, the other differential diagnosis can be perforated abdominal organs, like perforated duodenal ulcer. The simple investigation to do is an erect chest x ray, to look for any evidence of air under the diaphragm. Following this, an urgent CT-Abdomen is required to investigate any intra-abdom...
 (Total 113 words)
Based on the following data, there are certain risk factors that cannot be neglected. Chronic hypertension in a middle-aged smoker is a risk factor for both aortic dissection and abdominal aortic aneursym. The presence of sever abdominal pain with hemodynamic instability and anemia leads to the diagnosis of ruptured abdominal aortic aneurysm. It would be prudent to palpate the abdomen to check for a pulsatile mass. The diagnostic imaging of choice would be CT scan that is 100% sensitive for rupt...
 (Total 119 words)
Based on the following data, there are certain risk factors that cannot be neglected. Chronic hypertension in a middle-aged smoker is a risk factor for both aortic dissection and abdominal aortic aneursym. The presence of sever abdominal pain with hemodynamic instability and anemia leads to the diagnosis of ruptured abdominal aortic aneurysm. It would be prudent to palpate the abdomen to check for a pulsatile mass. The diagnostic imaging of choice would be CT scan that is 100% sensitive for rupt...
 (Total 119 words)
Based on the following data, there are certain risk factors that cannot be neglected. Chronic hypertension in a middle-aged smoker is a risk factor for both aortic dissection and abdominal aortic aneursym. The presence of sever abdominal pain with hemodynamic instability and anemia leads to the diagnosis of ruptured abdominal aortic aneurysm. It would be prudent to palpate the abdomen to check for a pulsatile mass. The diagnostic imaging of choice would be CT scan that is 100% sensitive for rupt...
 (Total 119 words)
Based on the following data, there are certain risk factors that cannot be neglected. Chronic hypertension in a middle-aged smoker is a risk factor for both aortic dissection and abdominal aortic aneursym. The presence of sever abdominal pain with hemodynamic instability and anemia leads to the diagnosis of ruptured abdominal aortic aneurysm. It would be prudent to palpate the abdomen to check for a pulsatile mass. The diagnostic imaging of choice would be CT scan that is 100% sensitive for rupt...
 (Total 119 words)