Abdominal Pain:  A Case Presentation Erik Manninen, CPT, MC PGY-1 Internal Medicine
History <ul><li>CC:  Abdominal pain and worsening agitation/mental status x 5 days </li></ul><ul><li>HPI:  85yo WM with di...
Exam <ul><li>VSSAF </li></ul><ul><li>8cm diameter suprapubic mass TTP </li></ul><ul><li>Right CVAT </li></ul><ul><li>CV:  ...
Differential Diagnosis <ul><li>AAA </li></ul><ul><li>Mesenteric ischemia </li></ul><ul><li>MI </li></ul><ul><li>Perforated...
Labs <ul><li>Cr 3.6 </li></ul><ul><li>Nl CBC, LFTs </li></ul><ul><li>Blood cx sent </li></ul>
Ancillary <ul><li>EKG with NSR </li></ul><ul><li>Renal/bladder US with right hydronephrosis and thin renal cortices consis...
Intervention <ul><li>Foley catheter drained 2500cc dark amber colored urine with gross hematuria near end of void with res...
Outcome <ul><li>Pt.’s Cr improved to 1.8 </li></ul><ul><li>Pt. Managed by IM with urology consult.  </li></ul><ul><ul><li>...
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Abd Pain ER Case Presentation

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Abd Pain ER Case Presentation

  1. 1. Abdominal Pain: A Case Presentation Erik Manninen, CPT, MC PGY-1 Internal Medicine
  2. 2. History <ul><li>CC: Abdominal pain and worsening agitation/mental status x 5 days </li></ul><ul><li>HPI: 85yo WM with diffuse abd. pain for 5 days, increased urinary frequency, and worsening mentation at night. </li></ul><ul><li>PMH: BPH and dementia. </li></ul><ul><li>PSH: ? </li></ul><ul><li>All: NKDA </li></ul><ul><li>Meds: Detrol and ambien started one week PTP. </li></ul>
  3. 3. Exam <ul><li>VSSAF </li></ul><ul><li>8cm diameter suprapubic mass TTP </li></ul><ul><li>Right CVAT </li></ul><ul><li>CV: RRR no m/r/g </li></ul><ul><li>Lungs: CTAB </li></ul>
  4. 4. Differential Diagnosis <ul><li>AAA </li></ul><ul><li>Mesenteric ischemia </li></ul><ul><li>MI </li></ul><ul><li>Perforated peptic ulcer </li></ul><ul><li>Obstruction </li></ul><ul><li>Pancreatitis </li></ul><ul><li>Diverticulitis </li></ul><ul><li>Nephrolithiasis </li></ul><ul><li>Acute cholecystitis </li></ul><ul><li>Appendicitis </li></ul><ul><li>Gastroenteritis </li></ul><ul><li>Non-ulcer dyspepsia/PUD </li></ul><ul><li>UTI/Pyelonephritis </li></ul>
  5. 5. Labs <ul><li>Cr 3.6 </li></ul><ul><li>Nl CBC, LFTs </li></ul><ul><li>Blood cx sent </li></ul>
  6. 6. Ancillary <ul><li>EKG with NSR </li></ul><ul><li>Renal/bladder US with right hydronephrosis and thin renal cortices consistent with CRD </li></ul>
  7. 7. Intervention <ul><li>Foley catheter drained 2500cc dark amber colored urine with gross hematuria near end of void with resolution of suprapubic mass. </li></ul><ul><li>Discontinuance of detrol/ambien. </li></ul><ul><li>Admission and monitoring of electrolytes along with fluid replacement for post-obstructive diuresis. </li></ul>
  8. 8. Outcome <ul><li>Pt.’s Cr improved to 1.8 </li></ul><ul><li>Pt. Managed by IM with urology consult. </li></ul><ul><ul><li>Started on proscar (finasteride) and flomax (tamsulosin). </li></ul></ul><ul><li>MS changes attributed to sundowning, given haldol on cross-cover. </li></ul>

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