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

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

Abdomen Blood

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

Abdomen

Does procalcitonin have a role in the management of acute appendicitis?

A 18 yo man comes to the ED in the morning because of low abdominal pain, fever and nausea. At palpation there is mild pain in the right inferior quadrant, not guarding. Could procalcitonin (PTC) helps to exclude quickly an acute appendicitis? Conclusion The figures are clear. We cannot use the PCT to…

ByCiro Paolillo10 October 20120Comments

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

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

Acute appendicitis and signs

A 21 y/o man presents to the ED with pain in right low quadrant (RLQ) , anorexia, nausea and vomiting. His abdomen is soft, with a mild tenderness in RLQ, the psoas sign is positive. The pain is aggravate by cough. You perform kindly a rectal examination with pain. Are this signs useful for the…

ByCiro Paolillo1 December 20110Comments

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

Abdomen

Acute appendicitis and Symptoms

A 21 y/o man presents to the ED with pain in right low quadrant (RLQ) , anorexia, nausea and vomiting. His abdomen is soft, with a mild tenderness in RLQ, the psoas sign is positive. The pain is aggravate by cough. You perform kindly a rectal examination with pain. Are this signs useful for the…

ByCiro Paolillo21 October 20110Comments

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

How have you come to the hospital?

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

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

Does procalcitonin have a role in the management of acute appendicitis?

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

Bowel obstruction and physical examination

Acute appendicitis and signs

Intestinal Ischemia and Lactate

Acute appendicitis and Symptoms

Septic Arthritis

Septic Arthritis and Arthrocentesis

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