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Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?

A 66 yo man complains of left lower quadrant (LLQ) abdominal pain from 4/5 hours. The pain is described as crampy initially, than continuous, there is not vomit. Temperature is 37.5°C. Abdomen is treatable, with moderate pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. ED US excluded the…

ByCiro Paolillo7 March 20130Comments

Blood

Is CRP useful alone to support the hypotesis of a bacteremia?

I t’s a very cold February, but ED is very hot in every sense of the word. A 22 y/o student refers stomach pain, chills, fever and diffuse muscolar pain. He has fever (38° C) there is a mild diffuse abdominal pain. The CRP value is 30 mg/L. Are there flu symptoms,…

ByCiro Paolillo25 February 20130Comments

Abdomen

Is CRP correlated to CT result in the evaluation of abdominal pain?

A 74 yo/man complained of diffuse abdominal pain. The pain was intermittent and accompained by vomiting. He has no history of abdominal pain or abdominal surgery. On examinations the patient presented non icteric, afebrile, not tachicardic. The abdomen was mildly distensed with midline tenderness. The US evidenced a normal aorta diameter. Abdominal…

ByCiro Paolillo10 May 20120Comments

Abdomen Ultrasound

Does Murphy’s sign and sonographic Murphy sign have the same clinical utility?

A 40 yo woman presented to the ED with upper quadrant pain since three hours after eating a tasty pizza. She is overweight, she presents feverish (38°C) her skin is nonicteric. The abdomen is soft, there is tenderness on the upper right quadrant, you perform a deep palpation in the subcostal area, and the patient…

ByCiro Paolillo15 April 20120Comments

Abdomen

Rectal Examination and Appendicitis

A 25 y/o man comes to the ED because of abdominal pain started 2 hours before, fever and vomit. He has not history of disease, no history of surgery, no history of other ED admission for abdominal pain. Clinical examination shows rigidity and diffused painfull abdomen. You perform digital rectal examination were you evidence no…

ByIlenia Spallino18 March 20120Comments

Abdomen

Bowel obstruction and physical examination

A 75 y/o man arrives in ED from a nursing. He complains abdominal pain. No fever, no jaundice, abdomen presents distended. Inspection shows a midline old scar, there is diffuse rigidity, increased bowel sounds and vomit on the sheets. Can history and clinical examination contribute to diagnosis of bowel obstruction? …

ByCiro Paolillo10 February 20120Comments

Abdomen

Intestinal Ischemia and Lactate

A 84 y/o woman comes accompained by relatives for abdominal pain. She is oriented and cooperative, she suffers pain (NRS 10/10). Abdomen is treatable, but very painful in the lower quadrants, you see green watering diarrhea, she has not fever. Abdominal Radiograph shows air/fluid levels WBC: 35000/μl PCR: 22 mg/L Lactate: 1,7 Can you rule…

ByIlenia Spallino23 November 20110Comments

The Emergency Physician

Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?

Is CRP useful alone to support the hypotesis of a bacteremia?

Is CRP correlated to CT result in the evaluation of abdominal pain?

Does Murphy’s sign and sonographic Murphy sign have the same clinical utility?

Rectal Examination and Appendicitis

Bowel obstruction and physical examination

Intestinal Ischemia and Lactate

Septic Arthritis

Septic Arthritis and Arthrocentesis

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