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  #1  
Old 08-25-2012
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Default GI question

A 46-year-old man is brought to the emergency department after being involved in a motor vehicle accident.He is unresponsive and his injuries include a basilar skull fracture ,brain contusion,fractures of ribs 7-10,hemopneumaothorax on the right,and a pelvic fracture.After placement of a chest tube and pelvic fixation,his condition stabilizes.on the fifth day of his hospital stay,he is still unresponsive with a Glasgow coma scale of 8 and spontaneous respiration.examination shows an abnormal facial reaction with palpation of the right upper quadrant of the abdomen and diminished bowel sounds.rectal examination shows no abnormalities .nasogastric tube aspiration shows retention of gastric contents.An abdominal CT scan shows gaseous distention of the small and large bowels without air-fluid levels .the gallbladder is distended with pericholescystic fuil but no gallstones.which of the following is the most likely diagnosis of the patients abdominal findings
A.Bowel obstruction
B.Cholecystitis
C.Pancreatitis
D.Mesentric ischemia
E.Lung contusion

I need help with this questions.please explain .Thank you
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Old 08-25-2012
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looks like D ........... mesentric ischemia due to loss of blood from fractures and haemothorax ......

not an obstruction as no air fluid level ......
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the presentation looks similar to acute acalculous cholecystitis due to the following findings

RUQ pain on palpation-confirmed by abnormal facial expression
severe trauma
no gallstones on US
distended GB

Is the answer B.....?
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Matched!!!
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Quote:
Originally Posted by anomali View Post
the presentation looks similar to acute acalculous cholecystitis due to the following findings

RUQ pain on palpation-confirmed by abnormal facial expression
severe trauma
no gallstones on US
distended GB

Is the answer B.....?

hmm .. looks like it ....... i missed it........
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Anyone else want to try ?
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Lung contusion.

As the fluid irritating the bowel causing bowel ileus.
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Quote:
Originally Posted by step_enhancer View Post
Anyone else want to try ?
nope whats the ans ..............
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Old 08-25-2012
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Quote:
Originally Posted by step_enhancer View Post
A 46-year-old man is brought to the emergency department after being involved in a motor vehicle accident.He is unresponsive and his injuries include a basilar skull fracture ,brain contusion,fractures of ribs 7-10,hemopneumaothorax on the right,and a pelvic fracture.After placement of a chest tube and pelvic fixation,his condition stabilizes.on the fifth day of his hospital stay,he is still unresponsive with a Glasgow coma scale of 8 and spontaneous respiration.examination shows an abnormal facial reaction with palpation of the right upper quadrant of the abdomen and diminished bowel sounds.rectal examination shows no abnormalities .nasogastric tube aspiration shows retention of gastric contents.An abdominal CT scan shows gaseous distention of the small and large bowels without air-fluid levels .the gallbladder is distended with pericholescystic fuil but no gallstones.which of the following is the most likely diagnosis of the patients abdominal findings
A.Bowel obstruction
B.Cholecystitis
C.Pancreatitis
D.Mesentric ischemia
E.Lung contusion

I need help with this questions.please explain .Thank you
Iīd say B cholecystitis, as the presence of pericholescytic fluid signifies this diagnosis with RUQ pain.

The presence of small and large bowel gaseous distension without fluid air level may be due to paralytic ilies so rule out A

C as itīs negative in Abd. CT
D may present with rectal bleeding
E
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Answer is C. Cholecystitis

i.e acalculous cholecystitis
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MY doubt is why isn't messentric ischemia -The presence of small and large bowel gaseous distension without fluid air level and retention of gastric contents ,made me choose messentric ischemia .
Does these signs occur in cholecystitis ??

can anybody explain
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Quote:
Originally Posted by step_enhancer View Post
MY doubt is why isn't messentric ischemia -The presence of small and large bowel gaseous distension without fluid air level and retention of gastric contents ,made me choose messentric ischemia .
Does these signs occur in cholecystitis ??

can anybody explain
Well these findings are not related to cholecystitis unless thereīs perforation and subsequent peritonitis.
Cholecystitis findings are edema of the bladder wall, pericholecystic fluid, and sometime air in the bladder wall.
But these finding in the case may be related to ileus
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Quote:
Originally Posted by Anders View Post
Well these findings are not related to cholecystitis unless thereīs perforation and subsequent peritonitis.
Cholecystitis findings are edema of the bladder wall, pericholecystic fluid, and sometime air in the bladder wall.
But these finding in the case may be related to ileus
So those findings are due to post trauma Ileus .now it makes sense .thanks
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Quote:
Originally Posted by step_enhancer View Post
So those findings are due to post trauma Ileus .now it makes sense .thanks
Could be trauma, pain medication and surgery
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Old 08-26-2012
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Quote:
Originally Posted by step_enhancer View Post
So those findings are due to post trauma Ileus .now it makes sense .thanks
Too much confusing question,where you got it ??
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