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Old 09-06-2012
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Default Abdominal pain

A 23-year-old man presents to the emergency room complaining of severe abdominal pain.He has also suffered from nausea and vomiting for several hours. His past medical history is insignificant, but his brother has had a similar problem requiring surgery. He denies risky behavior and IV drug use. On exam, his temp is 101.8F, HR 102 /min and resp 14/min. There is tenderness in the right upper quadrant exacerbated by deep inspiration.The liver is 7 cm.His spleen is plapated 2 cm below the left costal margin.The are no peritoneal signs.Which is the most likely diagnosis?

A. Acute viral hepatitis
B. Acyte pancreatitis
C. Gaucher's disease
D. Hodgkinss disease
E. Hereditary spherocytosis
F. Infectitous mononnucleosis
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Originally Posted by step_enhancer View Post
A 23-year-old man presents to the emergency room complaining of severe abdominal pain.He has also suffered from nausea and vomiting for several hours. His past medical history is insignificant, but his brother has had a similar problem requiring surgery. He denies risky behavior and IV drug use. On exam, his temp is 101.8F, HR 102 /min and resp 14/min. There is tenderness in the right upper quadrant exacerbated by deep inspiration.The liver is 7 cm.His spleen is plapated 2 cm below the left costal margin.The are no peritoneal signs.Which is the most likely diagnosis?

A. Acute viral hepatitis
B. Acyte pancreatitis
C. Gaucher's disease
D. Hodgkinss disease
E. Hereditary spherocytosis
F. Infectitous mononnucleosis
E. Hereditary spherocytosis The only condition among the choices which requires surgery.

Quote:
The major complications are aplastic or megaloblastic crisis, hemolytic crisis, cholecystitis and cholelithiasis, and severe neonatal hemolysis.
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Old 09-06-2012
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Ans..........E..........
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Originally Posted by step_enhancer View Post
A 23-year-old man presents to the emergency room complaining of severe abdominal pain.He has also suffered from nausea and vomiting for several hours. His past medical history is insignificant, but his brother has had a similar problem requiring surgery. He denies risky behavior and IV drug use. On exam, his temp is 101.8F, HR 102 /min and resp 14/min. There is tenderness in the right upper quadrant exacerbated by deep inspiration.The liver is 7 cm.His spleen is plapated 2 cm below the left costal margin.The are no peritoneal signs.Which is the most likely diagnosis?

A. Acute viral hepatitis
B. Acyte pancreatitis
C. Gaucher's disease
D. Hodgkinss disease
E. Hereditary spherocytosis
F. Infectitous mononnucleosis

Answer
E. Hereditary spherocytosis

Straight forward...- hemolytic anaemia with Gall bladder stones and cholangitis..
History of splenectomy for sibling
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Spherocytosis.

In the RUQ there is a cholelithiasis probably from too much of bilirubin from hemolysis and spleen is huge because of increased work that it produces (extravacular hemolysis, cuz spherocytes cannot squeeze through tight vessels in the spleen and macrophages destroy them)

Get him to the OR!
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Get him to the OR!
I wouldn't. I will treat his cholecystitis conservatively and schedule him for elective cholecystectomy and splenectomy at the same time.
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Originally Posted by Novobiocin View Post
I wouldn't. I will treat his cholecystitis conservatively and schedule him for elective cholecystectomy and splenectomy at the same time.
Ok, actually thats what I would do - percutaneously drain his bladder for a while, stabilize him and perform the surgery.
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Quote:
Originally Posted by step_enhancer View Post
A 23-year-old man presents to the emergency room complaining of severe abdominal pain.He has also suffered from nausea and vomiting for several hours. His past medical history is insignificant, but his brother has had a similar problem requiring surgery. He denies risky behavior and IV drug use. On exam, his temp is 101.8F, HR 102 /min and resp 14/min. There is tenderness in the right upper quadrant exacerbated by deep inspiration.The liver is 7 cm.His spleen is plapated 2 cm below the left costal margin.The are no peritoneal signs.Which is the most likely diagnosis?

A. Acute viral hepatitis
B. Acyte pancreatitis
C. Gaucher's disease
D. Hodgkinss disease
E. Hereditary spherocytosis
F. Infectitous mononnucleosis

BTW, this is straight UW question, id 4333

Please mark the topic as a SPOIL next time

- that's why we pay money for the q-bank.
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Quote:
Originally Posted by DocSikorski View Post
BTW, this is straight UW question, id 4333

Please mark the topic as a SPOIL next time

- that's why we pay money for the q-bank.
Okay I will mention next time.Thanks
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Last edited by step_enhancer; 09-06-2012 at 09:04 PM.
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Old 09-07-2012
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Originally Posted by DocSikorski View Post
Ok, actually thats what I would do - percutaneously drain his bladder for a while, stabilize him and perform the surgery.
You don't drain the Gall bladder in uncomplicated cholecystitis. You only drain it in complicated cholecystitis e.g. empyema of GB.
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Quote:
Originally Posted by step_enhancer View Post
A 23-year-old man presents to the emergency room complaining of severe abdominal pain.He has also suffered from nausea and vomiting for several hours. His past medical history is insignificant, but his brother has had a similar problem requiring surgery. He denies risky behavior and IV drug use. On exam, his temp is 101.8F, HR 102 /min and resp 14/min. There is tenderness in the right upper quadrant exacerbated by deep inspiration.The liver is 7 cm.His spleen is plapated 2 cm below the left costal margin.The are no peritoneal signs.Which is the most likely diagnosis?

A. Acute viral hepatitis
B. Acyte pancreatitis
C. Gaucher's disease
D. Hodgkinss disease
E. Hereditary spherocytosis
F. Infectitous mononnucleosis

E.) hereditary spherocytosis
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Answer E

Hereditary spherocytosis is an autosomal dominant disorder of spectrin, the protein that provides scaffolding for red blood cells. In this disease, the red blood cell is not deformable and gets trapped in the fenestrations of the spleen's red pulp. Classic findings are a positive family history ,splenomegaly and spherocytosis with increased reticulocytes on peipheral blood smear. Chronic hemolysis can caude jaundice and pigmented (Calcium biluribinate ) gallstones.This patient has acute cholecystitis due to pigmented stones.the treatment is folate supplement and splenectomy.
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