ZambianDoctors.com Blog

Abdominal pain

mmunx — Mon, 02 Jul 2007 05:09:31 +0000

A 62yr old lady presents to the Emergency Department complaining of a painful right hip after slipping and falling onto the concrete ground on her right side.

She has a past history of a right hip replacement about a month ago for unexplained AVN of the femoral head. And she also has a history of alcoholic pancreatitis for which her last admission was about 15 months ago. Other than that, she is normally fairly fit and well!

On examination, her general condition is stable, she is apyrexial and her other obs are stable. Her right hip is tender to palpate but there is no obvious shortening or external rotating of the limb.

She has an xray that show the following:

She is admitted placed nil by mouth from midnight, put on IV fluids, prescribed IV morphine for pain relief and scheduled for theatre the next day.

At around midday the next day, she complains of a 2 hour history of worsening abdomnal pain and distention. She claims not to have opened her bowels for the past 2 days and last passed flatus several hours ago. On examination she is apyrexic, with a normal BP, pulse, resps and sats. But her abdomen is obviously distended, very tender and she is guarding!

She has bloods taken that show

Hb 123

WCC 3.7

Neut 6.7

Na 140

K 3.5

Urea 2.3

Creatinine 0.06

LFT’s Normal

Lipase 187 H

Amylase 42

CRP 29 H

An xray of her abdomen shows

Three hours later, the pain has not subsided, she becomes pyrexic at 38.2 deg celsius and generally looks unwell. She has a CT scan as shown below

So questions

What is the incidence of such type of fractures?
Based on her initial abdominal complaints and presentation prior to the temperature spike, what are your possible differentials?
What does the CT show and how should she be managed?
How should she be managed on the overall taking into account all her problems on this admission?

Space Occupying lesion

mmunx — Tue, 26 Jun 2007 02:11:06 +0000

A 82yr old man who lives alone presents to the Emergency Department brought in by a neighbour, with a 4hr history of seizures. He’s had at least two episodes, each lasting just about a minute.

The neighbour states that he has been generally unwell for the past 3 weeks and been ‘acting more confused’ over that period of time

He has a CT scan as shown below:

Sorry about the quality but thoughts on differentials and management!

Munanga

Welcome

mmunx — Tue, 19 Jun 2007 20:51:02 +0000

Hi guys,

Welcome to the ZambianDoctors.com Blog!

As this is meant to be viewer-driven, your input both by bring cases to discuss and pondering on those put up for discussion, will shape the form of the blog!

Hopefully this will turn out to be a more than just the ‘quadrangle‘ brought online but eventually turn out to be a resource place and a reliable place to discuss amongst other things, the unique cases we say in Zambia and the Diaspora at large!

Munanga