case 11 from Tanta tropical centre

general aspect: 24 years old female is noticed to have rapidly developing diffuse abdominal distention within 20 days.on examination no jaundice ,no ll edema, no organomegally,just pallor and dullness allover the abdomen.

by investigations :

HB:10.2

prothrombin activity:92%

liver functions:billirubin D:0.2

IND:0.8

SGPT :22

SGOT :26

albumin:3.6gm

ascitic fluid :total protein 5 (normally no ascitic fluid or protein)and no RBCS, cells:50

U.S:hepatosplenomegally ,cirrhotic liver,patent portal vein

E.S.R:32,68

WHAT IS YOUR DIAGNOSIS

case 10

general aspect:49 years old male with periumbilical abdominal pain ,fever and diarhoea for 5 days

no rash no ronchi no splenomegaly yet

leuckocytic count is 12600

CRP is 96 mg/L

against widal in this case is :choose

leuckocytosis

duration of symptoms

diarhoea

all of the above

after 1 weaks he developed severe epigastric tenderness and mild generalized abdominal

distention

U.S showed thrombosis of the left branch of portal vein

how to manage this case.......

case 9

thanks Dr semsema for your useful participation

] semsema يقول...
أول مشاركة لي في المدونة ويارب تفيدكم

male patient aged 45 ,came to hospital complaining of feeling drowsy during doing exercise in the morning and some dysnea last night,nausea and mild chest pain which releaved spontaneously he had D.M 5 years ago and it is controlled by treatment

how to deal with this case??

case 8

thanks dr_roda for your successful participation

dr_roda يقول...
male patient aged50 years old came to emergency room with his family he was conscious and can wake but he was very annoying as he suffers from severe epigastric pain refered to his left shoulder from two hours and it is the first time.his history revealed only that he is smoker from 30 years ago and he never complained before.his blood pleasure was120/80and his pulse rate was 72b/min.by examination of abdomen nothing except epigastric tendernes. by heart examintion heart sounds just audible but no murmurs.what is your dignosis and how to manage??دى حاله جيت الطوارىء انا كشفت عليه وبعدين طلبت مساعده دكتور امتياز لانى شكيت فى حاجه وبعدين هو فحصها وتناقشنا وعايزه اشوف رايكم وان شاء الله هعرفكم طلعت ايه

اقتراحات

هذه الرساله لتلقى اقتراحات الزملاء واى طلبات لتطوير المدونه وعرض الحالات .وشكرا لجميع الزملاء

case 7

male patient 56years old is noticed to have pallor , jaundice, splenomegally and orthopnea
he is known to be hepatic and received blood at different times


his lower right chest was dull in percussion. his Hb was as follows

his x_ ray as follows showing obliteration of the angle




questions
CBC will show : choose
hypochromic anemia
leukocytosis
reticulocytosis
abnormal cells

for management : choose
surgical splenectomy
radio splenectomy
continuous blood transfusion
iron supplementaion

case 6

.a10 years girl presented with dehydration ,vomitting and abdominal pain for 10 days

her x_ray showed suspicious of intestinal obstruction as fluid levels but it were ordinary gases

fortunately, anurse noticed actone odour from her breath.

.she was managed butwhile therapy she arrested twice and now she is under ventilation in ICU.

questions

diagnosis?

if brain edema ocurred while therapy mannitol is contraindicated(t/f).choose

normal potassium levels monitored by ECG before therapy indicates potassium supplementation.(t/f) choose

to confirm your diagnosis and exclude intestinal obstruction :choose

serum amylase

urine analysis

ECG

serum electrolytes