Case of the Week

Puffy Belly



A 59-year-old woman with a history of dyspepsia complains of one day of crampy
epigastric pain associated with nausea.  She describes this pain as different from her chronic post-prandial pain.  She reports no fever, back pain, chest pain, or other associated symptoms.  The woman recalls a “gall bladder surgery” years ago for gall stones.

On examination, T 98.4 C 160/70 HR 82 RR 12 SpO2 98% RA.  She is uncomfortable and has moderate epigastric tenderness to palpation without evidence of peritonitis. Her rectal examination is normal; stool is guaiac negative.

WBC 12.1 with elevated polymorphonuclear cells; chemistries, liver function tests,
and lipase are normal.  Her bedside right upper quadrant ultrasound was technically difficult, thought to be due to interference with intestinal gas scattering.  Due to her significant symptoms, tenderness to palpation, elevated white blood cell count with left shift, and unclear picture, a CT was performed:
Which of the following is the MOST likely etiology of her CT findings?

     A. Mesenteric ischemia
     B. Cholecystitis
     C. Small bowel obstruction
     D. Ulcerative colitis

In the meantime, a quote ‒

Symptoms, then are in reality nothing but the cry from suffering organs.

Leçons cliniques sur les maladies des vieillards et les maladies 

Jean Martin Charcot (1825-1893)


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