EMDoc

Archive for September, 2011|Monthly archive page

The stroke of insight.

In Uncategorized on September 30, 2011 at 2:09 am

A fascinating TED talk from a neuroanatomist who studied her own stroke as it happened!

 

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Abdominal Pain

In Uncategorized on September 12, 2011 at 7:50 pm

 34 yo M with no PMH presents 2/2 diffuse abd pain that began yesterday AM after waking. It has worsened since onset. It is intermittent, pressure-like. No n/v, no f/c, no diarrhea. No urinary sxs. Pain is worse with eating or ambulating. No relief with motrin, maalox, or peptobismol. Pain radaites around to his lower back. Pain is moderately severe. Pt has never had this pain before. Pt also tried a “Mexican medication” for his belly pain with no relief. 

On exam pt appears nontoxic and in no acute distress. RRR heart sounds, Pulm exam CTA b/l, no CVAT, abd exam with mild-moderate epigastric ttp without rebound or guarding, no abd masses.
Labs were ordered.
45mins later, the lab called to state ‘we cannot run the labs because the patient’s blood is ‘milky”
RN was asked to redraw the blood work, and this was noted in the patient’s room.
WHAT IS THE DIAGNOSIS?
 Cholesterol                              666        H      (150-250)        mg/dL
  Result Comment:
 HDL-Cholesterol                          70                                 mg/dL
 Non-HDL Chol (Calc)                      596                                mg/dL
 Direct LDL:                              42                (0-100)          mg/dL
 Triglyceride                             3937
 Lipase                                   44                (13-60)          U/L

IMPRESSION:

Peripancreatic stranding with thickening of the anterior renal and

lateral conal fascia consistent with acute pancreatitis. No

collections identified.

I thought this was a very cool case! The 2 most common causes of pancreatitis are alcohol(35%) or gallstones (40%). Other causes include post-ERCP, trauma, and Infection.

In medical school we learn the other rare but possibly causes – such as hypertriglyceridemia (<1%)! Usually occurring with TG’s >1000. Remember acute pancreatitis doesn’t always present with an elevated lipase (especially if the pancreas is pretty burned out prior to presentation).

REMember – management of acute pancreatitis – NPO, IVF, admit!