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Blood test and urgent abdominal conditions

A 44 YO man presents to the ED complaining of abdominal pain. He was well until 4 hours ago, when he developed diffuse abdominal pain. This is the first time he suffers abdominal pain. He has not history of surgery. The patient is afebrile, HR is 80, BP is 180/100, ECG is normal. The abdomen…

ByCiro Paolillo1 January 20160Comments

Abdomen

Where is peritonitis?

A 80 YO man with a history of hypertension presents to the ED complaining of abdominal pain. He felt well until 8 hours ago, when he developed diffuse abdominal pain. The patient is afebrile, tachicardic, BP is 180/100 his lungs are clear, ECG shows no changes suggestive of ischemia. There is diffuse abdominal rigidity. In…

ByCiro Paolillo27 April 20150Comments

Abdomen

Run to the operation room!

A 70 yo woman is brought to the ED by ambulance. She’s suffering from vomit, lach of flatus and abdominal pain since 24 hours says the nurse. She’s pale, the abdomen shows a midline scar. There is diffused tenderness with rebound. Abdomen US and X rays show abnormal distended loop of small bowel. Ok,…

ByCiro Paolillo19 January 20150Comments

Abdomen

Age of 45 and dyspepsia

It’s the begining of another night shift in ED. Rik, an agreable young colleague approximates: Hi- he says – I have just seen a 60 y/o man who refers epigastric pain since 2 days. He denies bleeding and weight loss, he isn’t anemic. The bedside US shows a normal gallbladder and a normal abdominal aorta,…

ByIlenia Spallino11 January 20140Comments

Abdomen

Clinical diagnosis of gastric ulcer. Does your gastroenerologist perform better?

A 35 yo smokerman presents at morning to the ED. He refers epigastric pain since seven days. The pain worses after eating, he refers nausea without vomit and he denies melena and weight loss. Palpation causes pain in epigastric region, there’s not fever, nor tachicardia, hemoglobin is 13 g/dL. Bedside US evidences a normal…

ByCiro Paolillo11 January 20140Comments

Abdomen

Plain X ray in suspected bowel obstruction. Is that all?

A 67 y/o woman arrives in the ED at 5pm because of diffused abdominal pain since 2 hours. She has nausea and she refers costipation from the day before. She has a history of hysterectomy 5 years before because of fibroma. Vital signs are normal, she presents pale and sufferer for pain, the abdomen…

ByIlenia Spallino11 November 20130Comments

Abdomen

Is it a subtle appendicitis? How to make time your friend (part two)

It’s about the end of the night shift, in Observation Unit there’s George a 25 yo male presented the evening before with a mild periumbilical pain since 2 days than localized to the right lower quadrant. He was afebrile with stable vital signs, in the car, arriving to the ED, there was vomit, not diahrrea.…

ByCiro Paolillo11 September 20130Comments

Abdomen

Is it a subtle appendicitis? How to make time your friend

Mr. Smith is a 39 yo man with abdominal pain. He has been visited, few hours ago, by his primary care doctor who sent him to you for a surgeon consult. He refers abdominal pain, fever and nausea since the day before. The pain was previously in the midabdomen, than it migrated to the right…

ByCiro Paolillo11 August 20130Comments

Abdomen

How have you come to the hospital?

It’s just started your night shift, Sara is a young EP, she is going home after an hard day. Hello - she says tired - could you help me? There is a guy with abdominal pain and nausea. I think it could be appendicitis, but there is not fever and not leukocytosis. Have you asked…

ByCiro Paolillo22 April 20130Comments

Abdomen

Imaging strategies of suspected acute colonic diverticulitis: how does it work?

A 66 yo man complains of left lower quadrant (LLQ) pain, anoressia and fever, it is the first time. The pain is acute, there is not vomit, temperature is 38°C. Abdomen is treatable, with severe pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. Probably this patient suffers of…

ByCiro Paolillo10 April 20130Comments

The Emergency Physician

Blood test and urgent abdominal conditions

Where is peritonitis?

Run to the operation room!

Age of 45 and dyspepsia

Clinical diagnosis of gastric ulcer. Does your gastroenerologist perform better?

Plain X ray in suspected bowel obstruction. Is that all?

Is it a subtle appendicitis? How to make time your friend (part two)

Is it a subtle appendicitis? How to make time your friend

How have you come to the hospital?

Imaging strategies of suspected acute colonic diverticulitis: how does it work?

Septic Arthritis

Septic Arthritis and Arthrocentesis

Is cervical spine X-ray necessary if there is a distracting injury?