advertisement

ACD 10/16: A case of abdominal pain

56 %
44 %
advertisement
Information about ACD 10/16: A case of abdominal pain
Health & Medicine

Published on October 22, 2014

Author: nngowen

Source: slideshare.net

Description

Internal Medicine
advertisement

1. ACD 10/16/2014 JORGE JO KAMIMOTO MD PGY 2 IM

2. Simulated case presentation  Elderly man that presents to ED for:  Intermittent abdominal pain on and off for 1 week associated with constipation  Usually notices it after eating or drinking  Subjective fever for 24 hours

3.  PMH:  CAD, HTN, HLPD, DM II  UTD on colo screening

4.  Vitals:  Bp 125/75 mmHg, Hr 130, RR 18, Temp 101.5 F  Physical exam  No apparent distress  Gi: Soft, tender to deep palpation in epigastrium and RUQ, BS+  Rest of exam is unrevealing

5.  Cbc WNL, BMP shows slight AKI and slight metabolic anion gap acidosis.  UA and LFTs again unremarkable

6. What is your differential diagnosis?

7.  The ED isn’t sure, but worried about a lot of things that show up on CT, so they get a CT abdomen/pelvis with IV and oral contrast. It shows….

8.  …thrombus noted in the superior mesenteric vein extending into the portal veins with some subsegmental occlusion noted. There is a small foci of air associated with thrombus. No pneumoatosis and no free air…

9. What should you do next?

10. Mesenteric vein thrombosis JORGE JO KAMIMOTO MD PGY 2 IM

11. Pathogenesis  Primary vs Secondary  Secondary in 75% of cases  Conditions associated with mesenteric vein thrombosis

12. History and work up  Age of presentation 40 -60 years mostly males  50% personal or family history of blood clots  75% of patients symptomatic for 48 hours or more at presentation  Common presenting symptoms:  Mid abdominal pain disproportionate to exam  Nausea, vomiting, diarrhea, constipation  Poor outcome predictors:  Fever (infection vs ischemia), Hemodynamic instability, Peritoneal signs

13. Diagnosis  Usually made non invasively  Plain abdominal films  Abnormalities 50 -75 % cases  Nonspecific findings: dilated bowel loops, ileus and mucosal edema  Can help to detect perforation  CT abdomen with contrast  Diagnostic modality of choice  90% accuracy  Bowell wall thickening more than 10mm 90% accuracy for infarction

14. Work up

15. Work up  JAK2V617F screening in SVT patients without typical hematological MPN features identified MPN in 17.1% and 15.4% of screened BCS and PVT patients, respectively. It can be concluded that besides bone marrow histology, screening for JAK2V617F is an important diagnostic tool to detect MPN in these patients and should be performed in all patients with abdominal vein thrombosis as part of the standard diagnostic work-up.

16. Relationship between PNH and Splanchnic vein thrombosis  Flow cytometry, using monoclonal antibodies against CD55 and CD59, may identify PNH in a subclinical state when clinical and laboratory signs of hemolysis are still lacking.

17. Treatment  Can be managed medically if no evidence of infarction  Anticoagulation with LMWH should be started immediately after diagnosis  If there is no need for invasive procedures start anticoagulation with oral agent  Continue anticoagulation for 6 months if known reversible condition  Anticoagulation for life in pro-thrombotic states and idiopathic  Broad spectrum antibiotics if evidence of infection  Supportive care includes:  Bowel rest, NS suction, fluids/electrolyte/blood product replacement

18. References

Add a comment

Related presentations

Presentation at the EABCT Congress 2014 about a Metacognitive Model of Craving

Calcification Inhibitors in CKD and Dialysis Patients

Related pages

Acd | LinkedIn

View 61794 • Acd posts, presentations, experts, and more. Get the professional knowledge you need on LinkedIn. LinkedIn Home What is LinkedIn? Join Today
Read more

Differential diagnosis of left-sided abdominal pain ...

... primary epiploic appendagitis vs colonic diverticulitis. ... In cases of left ACD, ... Abdominal Pain/etiology; Abdominal Pain/radiography;
Read more

Left Lower Quadrant Pain-Suspected Diverticulitis-ET

Left Lower Quadrant Pain — Suspected Diverticulitis ... Of 1,290 patients with acute abdominal pain, ... colon and could be performed in cases where
Read more

Intra-Abdominal Lymph Node Metastases in Low-Third ...

... a Case of Incidental pM1a ... On 2007/10/16, ... Review of systems: increase bowel activity and abdominal pain after oral feeding in recent days. O: 1.
Read more

Case 16-1969 — Weight Loss, Abdominal Pain, Anorexia and ...

Case 16-1969 — Weight Loss, Abdominal Pain, Anorexia and Persistent Diarrhea. Kurt J. Isselbacher, and Austin L. Vickery, Jr. N Engl J Med 1969; 280:885 ...
Read more

Case 31-2013: A 29-Year-Old Man with Abdominal Pain, Fever ...

with Abdominal Pain, Fever, and Weight Loss Howard M. Heller, M.D., M.P.H., Carol C. Wu, ... case records of the massachusetts general hospital
Read more

Opioid Bowel Dysfunction and Narcotic Bowel Syndrome: A ...

... outpatients with chronic nonmalignant pain. Narcotic bowel syndrome ... chronic abdominal pain ... A case of narcotic bowel syndrome successfully ...
Read more

2016 ICD-10-CM Diagnosis Code R10.9 : Unspecified ...

2016 ICD-10-CM Diagnosis Code R10.9. ... you have abdominal pain that is sudden and sharp; you also have pain in your chest, neck or shoulder ;
Read more

A Seminar on ACD - Documents - Discover, share, present ...

Share A Seminar on ACD. ... ACD 10/16: A case of abdominal pain Internal Medicine ACD a strange case of pneumonia Internal Medicine
Read more