Case discussion - Acute Abdomen 65 yr, Female - Abdomen pain without shock Initial assessment - pt. Stable, conscious and able to talk , Airway patent, no pooling of secretions History - vomiting , Aggrevated on food consumption, no relieving factors, referred pain - back, no fever , no diarrhoea Similar past history - 2 months back vomiting only , no pain at that time Duration - since 4 days. Location - Epigastric Severity - 7/10 Onset - Gradual ( because she is bearing from 4 days) Character of pain - Continues BP - 160/80 mmhg SPO2 - 100 % on RA RR - 24 /min PR - 100/ min Examination Findings :- Per abdominal examination:- No Peristalsis , No Sinus, No discoloration, diffuse abdomen tenderness, soft abdomen, not distended Differential diagnosis:- • Acid Peptic disease • Peptic Ulcers • Pancreatitis • Gastritis Investigation:- • CBC - Normal • VBG shows no acid - base imbalance ( to figure out - Metabolic acidosis ) • no hypocalcaemia - which can be seen in Pancreatitis • Lactate - normal ( significance of Lactate in abdomen pain - Elevated lactate - Mesentric Ischemia ) • USG Shows - Atrophic Pancreas with dilated bile duct ( it happens due to chronic pancreatitis ) • Amylase and Lipase - Normal • aslo look for LFT , Alkaline phosphate • CT - shows Chronic calcific pancreatitis , mild hepatomegaly Management:- • NPO • PCM infusion • Opiods - Tramadol • Anti Emetic - Ondansetron / Metacloperamide • Electrolyte and Fluid management • Control Diabetes Structures that causes symptoms in Epigastric region - Liver ( Hepatitis) , Gallbladder ( cholecystitis, cholelithiasis ) , Gastritis ( most common), Pancreas ( Pancreatitis), Categories abdomen pain into :- • Abdomen pain with shock or without shock Or • Life threatening or without life threatening 4 questions to find out any abdominal pain :- 1. Onset - Gradual / Acute 2. Duration - 3. Severity - 4. Location - 5. Character of the Pain - Continues / Colicky Examples of Acute Abdominal pain :- • abdominal aortic aneurysm rupture • rupture ectopic pregnancy • perforation • ureteric colic • gastroenteritis Most important things during per abdominal examination:- 1. Tenderness 2. Organomegally If their is Tenderness - then also look for guarding, rigidity , rebond tenderness Possibility of Pain aggrivating on food consumption :- • Gastric Ulcers • Pancreatitis • cholecystitis ( usually right hypocondriac pain ) Relieving factors that we should ask :- Is pain decrease on bending forward. • Cholecystitis referred pain - Right shoulder • Appendicitis referred pain - Umbilical region to right lower abdomen • Ureteric calculus referred pain - lower abdomen and groin, back, flank pain.
Nice, appreciate your ways to differentiate causes. Thanks.
Thank you very much dear Dr.For this vital information
Thankyou Sir 🙏 and the entire ER team 👍😊🥰😁
We shouldn't left without thanking 🙏
Very wide discussion thank you sir !
Thank you sir
Thanks sir🙏🙏
Thanks
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Case discussion - Acute Abdomen
65 yr, Female - Abdomen pain without shock
Initial assessment - pt. Stable, conscious and able to talk , Airway patent, no pooling of secretions
History - vomiting , Aggrevated on food consumption, no relieving factors, referred pain - back, no fever , no diarrhoea
Similar past history - 2 months back vomiting only , no pain at that time
Duration - since 4 days.
Location - Epigastric
Severity - 7/10
Onset - Gradual ( because she is bearing from 4 days)
Character of pain - Continues
BP - 160/80 mmhg
SPO2 - 100 % on RA
RR - 24 /min
PR - 100/ min
Examination Findings :-
Per abdominal examination:-
No Peristalsis , No Sinus, No discoloration, diffuse abdomen tenderness, soft abdomen, not distended
Differential diagnosis:-
• Acid Peptic disease
• Peptic Ulcers
• Pancreatitis
• Gastritis
Investigation:-
• CBC - Normal
• VBG shows no acid - base imbalance ( to figure out - Metabolic acidosis )
• no hypocalcaemia - which can be seen in Pancreatitis
• Lactate - normal ( significance of Lactate in abdomen pain - Elevated lactate - Mesentric Ischemia )
• USG Shows - Atrophic Pancreas with dilated bile duct ( it happens due to chronic pancreatitis )
• Amylase and Lipase - Normal
• aslo look for LFT , Alkaline phosphate
• CT - shows Chronic calcific pancreatitis , mild hepatomegaly
Management:-
• NPO
• PCM infusion
• Opiods - Tramadol
• Anti Emetic - Ondansetron / Metacloperamide
• Electrolyte and Fluid management
• Control Diabetes
Structures that causes symptoms in Epigastric region - Liver ( Hepatitis) , Gallbladder ( cholecystitis, cholelithiasis ) , Gastritis ( most common), Pancreas ( Pancreatitis),
Categories abdomen pain into :-
• Abdomen pain with shock or without shock
Or
• Life threatening or without life threatening
4 questions to find out any abdominal pain :-
1. Onset - Gradual / Acute
2. Duration -
3. Severity -
4. Location -
5. Character of the Pain - Continues / Colicky
Examples of Acute Abdominal pain :-
• abdominal aortic aneurysm rupture
• rupture ectopic pregnancy
• perforation
• ureteric colic
• gastroenteritis
Most important things during per abdominal examination:-
1. Tenderness
2. Organomegally
If their is Tenderness - then also look for guarding, rigidity , rebond tenderness
Possibility of Pain aggrivating on food consumption :-
• Gastric Ulcers
• Pancreatitis
• cholecystitis ( usually right hypocondriac pain )
Relieving factors that we should ask :-
Is pain decrease on bending forward.
• Cholecystitis referred pain - Right shoulder
• Appendicitis referred pain - Umbilical region to right lower abdomen
• Ureteric calculus referred pain - lower abdomen and groin, back, flank pain.
Thank You
Thanku
Great
Kindly make videos on pediatric Emergencies like meconium aspiration and birth asphyxia and many others. Plz
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If u suspect a kidney stone also, would you order a CT scan with contrast or without contrast or both? Pls reply
Without contrast
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