Female, 60 years old, with abd
Female, 60 years old, with abdominal pain for 2 days.After 2 days’advance of eating greasy food, the pain in the midsection of theupper abdomen was gradually increased, and it gradually becamepersistent. It radiated to the lower back, and became worse whenlying on the back, coughing, or exercising. The abdominal pain wasnot relieved, and repeated use of analgesics was ineffective. Nosymptoms of cough, chest pain, diarrhea and urination since theonset. He has had cholelithiasis for many years, but has no historyof chronic upper abdominal pain, no history of acid reflux, blackstools, no clear history of heart, lung, liver, kidney disease, andno special records of personal history and familyhistory.
Examination: T39°C,P104 beats/min, R19 beats/min, Bp130/80mmHg, laterally curledposition of acute disease, dry skin, no bleeding spots, nosuperficial lymph nodes untouched, no sclera yellow staining, noabnormalities of the heart and lungs, abdominal Flat, mild muscletension in the upper abdomen, obvious tenderness, suspiciousrebound pain, no mass touched, negative Murphy sign, no obviouspercussion pain in the liver and kidney area, suspicious positivemobile dullness, slightly bowel sounds, and lower limbs not swollen.
Laboratory tests: blood Hb120g/L, WBC 22×109/L,N86%, L14%, plt 110×109/L.Urine protein (±),RBC 2-3/high power, urine amylase 32U, abdominal plain film notseen free gas and fluid level under the diaphragm, slightlyexpanded intestinal tract, serum BUN 7.0 mmol/L.
1. Diagnosis and diagnosis basis
2. Differential diagnosis
3. Further inspection
4. Treatment principles
Answer:
Upper midsextiof abdomen composed of part of liver andpancreas.
1. Based on given physical examination findings and labinvestigations done to patient the patient condition suspect aspancreatitis.
2. Differential diagnosis help to identify or distinguish otherdiseases which have same clinical symptoms. Hear serum amylaselevel helps as differential diagnosis ,in kidney problems amylaselevels remaining normal.In liver diseases liver enzymes elevate andcause diabetes too. And pain in upper abdomen and radiation to backpresent in pancreatitis only.
3. Further inspection need to do ,ultrasound abdomen, serumlipase. Assess for personal habits of smoking and alcoholism. Thesewill help us to investigate furthermore.Investigate for presence ofany infections.
4.Treatment principles of pancreatitis *Early aggressive fluidresuscitation. *intensive care with close monitor. *Antibioticsprophylaxis. *Early supportive treatment of organ failure. *Surgeryin infected pancreatitis.
Hemothorax is an accumulation of blood with in the pleuralcavity . It is presented with clinical signs chest pain,difficultyin breathing,reduced breath sounds on affected side,rapid heartrate. Causes for hemothorax are an injury to chest wall, cancerinvading the pleural cavity, blood clotting disorders. Clinicaldiagnosis is done by clinical symptoms and reported medicalproblems by the patient. *During physical examination we will hearabnormal breathing sounds. *On percussion of chest we will feel thesounds of fluid accumulation. By these methods clinical diagnosisof hemothorax done.
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