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Elderly Female with Abdominal Pain
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Available online at www.sciencedirect.com
Visual Journal of Emergency Medicine 4C (2016) 52–53 www.elsevier.com/locate/visj
Elderly Female with Abdominal Pain Michael A. Hayoun, MD, MPhiln, Deborah L. Pierce, DO, MS Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA
Keywords: febrile elderly; febrile abdominal pain; cholecystitis; enlarged gallbladder
Visual Case Discussion Pleasantly demented 82-year-old female nursing home resident with a history of DM2, HTN, HLD brought in by EMS for right-sided abdominal pain and hypertension. She does not answer open-ended questions, but points to her
Fig. Arrow pointing to multiple gallstones in the inferior portion of a grossly enlarged gallbladder. n
Corresponding author. E-mail address: [email protected] (M.A. Hayoun).
http://dx.doi.org/10.1016/j.visj.2016.02.021 2405-4690/& 2016 Elsevier Inc. All rights reserved.
M.A. Hayoun, D.L. Pierce / Visual Journal of Emergency Medicine 4C (2016) 52–53
53
epigastric and suprapubic areas when asked where it hurts. Pain is worse after eating. She denies fevers, chills, nausea, vomiting, dysuria, and diarrhea. Last BM was 1 day prior (Fig.). Vitals: T ¼ 381C, HR ¼ 115 bpm, BP ¼ 189/82, RR ¼ 22, O2 Saturation 98% on RA. Gen: Pleasantly demented 82-year-old female in no apparent distress. Abdominal exam: Mild tenderness to the RUQ and suprapubic regions, otherwise soft, non-distended with no rebound or masses appreciated. Labs: WBC ¼ 28 with 86% segs, Hgb ¼ 14.9, glucose ¼ 348, lipase ¼ 7, AST ¼ 55, ALT ¼ 44, alk phos ¼ 90, troponin ¼ 0.10, UA ¼ positive for bacteria, leukocyte esterase, WBCs. CT scan of the abdomen and pelvis with IV contrast revealed a gangrenous 4 21-cm gallbladder with numerous gallstones that extends down into the pelvis. The gallbladder wall was markedly thickened to 6.5 mm in some areas, as well as positive for pericholecystic fluid. Appendix. Supplementary Materials Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj. 2016.01.002.
References [1] Esses D, Birnbaum A, Bijur P, et al. Ability of CT to alter decision making in elderly patients with acute abdominal pain. Am J Emerg Med 2004;22(4):270–2. [2] Krupietzky A. Clinical guidelines for treatment of impalement injuries of the oropharynx in children. Pediatr Dent 2000;22(3):229–31. [3] Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med 2005;23(3):259–65.
Available online at www.sciencedirect.com
Visual Journal of Emergency Medicine 4C (2016) 52–53 www.elsevier.com/locate/visj
Elderly Female with Abdominal Pain Michael A. Hayoun, MD, MPhiln, Deborah L. Pierce, DO, MS Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA
Keywords: febrile elderly; febrile abdominal pain; cholecystitis; enlarged gallbladder
Visual Case Discussion Pleasantly demented 82-year-old female nursing home resident with a history of DM2, HTN, HLD brought in by EMS for right-sided abdominal pain and hypertension. She does not answer open-ended questions, but points to her
Fig. Arrow pointing to multiple gallstones in the inferior portion of a grossly enlarged gallbladder. n
Corresponding author. E-mail address: [email protected] (M.A. Hayoun).
http://dx.doi.org/10.1016/j.visj.2016.02.021 2405-4690/& 2016 Elsevier Inc. All rights reserved.
M.A. Hayoun, D.L. Pierce / Visual Journal of Emergency Medicine 4C (2016) 52–53
53
epigastric and suprapubic areas when asked where it hurts. Pain is worse after eating. She denies fevers, chills, nausea, vomiting, dysuria, and diarrhea. Last BM was 1 day prior (Fig.). Vitals: T ¼ 381C, HR ¼ 115 bpm, BP ¼ 189/82, RR ¼ 22, O2 Saturation 98% on RA. Gen: Pleasantly demented 82-year-old female in no apparent distress. Abdominal exam: Mild tenderness to the RUQ and suprapubic regions, otherwise soft, non-distended with no rebound or masses appreciated. Labs: WBC ¼ 28 with 86% segs, Hgb ¼ 14.9, glucose ¼ 348, lipase ¼ 7, AST ¼ 55, ALT ¼ 44, alk phos ¼ 90, troponin ¼ 0.10, UA ¼ positive for bacteria, leukocyte esterase, WBCs. CT scan of the abdomen and pelvis with IV contrast revealed a gangrenous 4 21-cm gallbladder with numerous gallstones that extends down into the pelvis. The gallbladder wall was markedly thickened to 6.5 mm in some areas, as well as positive for pericholecystic fluid. Appendix. Supplementary Materials Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj. 2016.01.002.
References [1] Esses D, Birnbaum A, Bijur P, et al. Ability of CT to alter decision making in elderly patients with acute abdominal pain. Am J Emerg Med 2004;22(4):270–2. [2] Krupietzky A. Clinical guidelines for treatment of impalement injuries of the oropharynx in children. Pediatr Dent 2000;22(3):229–31. [3] Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med 2005;23(3):259–65.