Friday3 - sammy08

[ArchivalUser]

A 65 year old woman is being admitted for worsening abdominal pain radiating to the back that started several hours ago. She states that she has had similar but not so intense pain recently. Her abdomen is soft, non distended and diffusely tender without rebound. Murphy's sign is positive. Bilateral costovertebral angle tenderness is present. Nasogastric tube shows bilious stomach content. Six hours later the pain is increasing despite the IV morphine and spasmolytic therapy. She begins to have bloody diarrhoea and becomes hypotensive and tachycardiac. Mottled cyanosis of the flanks is noted. Rebound tenderness if now present. What is the most likely diagnosis?

A. Acute pancreatitis
B. Acute diverticulitis
C. Henoch-Scholen purpura
D. Peptic ulcer disease with concomittant perforation and bleeding
E. Mesenteric thrombosis

[ArchivalUser]

ee?

[ArchivalUser]

d?

[ArchivalUser]

E. Mesenteric thrombosis

[ArchivalUser]

The correct answer is E

Clues to the diagnosis are the bloody diarrhoea and shock like features

[ArchivalUser]

sammy why +ve Murphy's sign,bilateral costoverebral angle tenderness,motled cyanosis of flanks?

[ArchivalUser]

Isn't it Acute pancreatitis,where the bloody flanks is grey turner sign and positive murphy cause the cause of pancreatitis is Gall Bladder stones, and it is Acute haemorrhagic pancreatitis leading to the bloody diarrhea...

[ArchivalUser]

I guess I have to post the full explanation here too..here's what our UW says


" Mesenteric thrombosis usually presents in a very non specific fashion. The pain may radiate to the back. Murphy's sign and CVA tenderness may be positive. In contrast to the other listed options, pain that can't be controlled with opiods is very suggestive of ischaemia. The bloody diarrhoea further argues in favour of the diagnosis. The mottled cyanosis is possibly due to the low cardiac output accompanying the bowel ischaemia. This phenomenon is different from Turner's sign in pancreatitis

Acute pancreatitis doesn't explain the bloody diarrhoea

[ArchivalUser]

thanks

[ArchivalUser]

thanks sammy