akflightmedic Posted April 28, 2007 Posted April 28, 2007 Hmmm, I am going to say maybe a peptic ulcer/duodenal ulcer. Has it perforated? My only other dx at this time is it is referred pain as a result of her pneumonia.
pyroknight Posted April 28, 2007 Posted April 28, 2007 He eats a normal diet. Vomit . . . . was at 1800 and she is afebrile. This patient was obviously undergoing paroxysmal, spontaneous gender reassignment which has resolved. Now that he has fully transformed into a she, the pain and vomiting should go away. Seriously, though, I would list cholecystitis at the top of my Diff Dx with IBS following in second. I would start a saline lock, get an ECG, 25 mcg fentanyl, 12.5 mg phenergan, a generous serving of bedside manner, and before you know it I'm handing my new friend over to ERDoc for labs, US, and the like.
Dustdevil Posted April 30, 2007 Posted April 30, 2007 Look up Cullen's and Turner's signs for a few examples. But, I am not saying these are the correct answer. If she has Cullen's or [Grey-]Turner's, alert the media! What was that meal she had at 1800? All my differentials have been covered here. At first I thought about PMC, but with normal BMs, that's not at all likely. It's probably going to take labs and an ultrasound to get a handle on this one.
ERDoc Posted April 30, 2007 Author Posted April 30, 2007 If she has Cullen's or [Grey-]Turner's, alert the media! What was that meal she had at 1800? All my differentials have been covered here. At first I thought about PMC, but with normal BMs, that's not at all likely. It's probably going to take labs and an ultrasound to get a handle on this one. This one is a tricky case. Like you guys I was thinking GB disease or something similar. The US and labs came back positive. With that much pain I did a CT and she had a rectus sheath hematoma (bleeding in the abd wall). Looking back on it now, she was pretty tender even with light indentation of the skin which would not be very consistent witrh an intraabdomenal cause. Turns out she ruptured one of her superficial arteries (inferior epigastric, I believe) with all of the coughing she was doing with her pneumonia. The ASA just made it worse. Good thoughts on everyones part though.
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