Transcript Slide 1

 ID
 CC
: 53 years old female
: Abdominal Pain
53 years old female
Abdominal pain since three days ago
generalized
Constant
Without radiation
Not related to the patient’s position
No relation to meals
Anorexia: +
Last defecation: 2 days ago
Gas passage : -
Vomiting : +
Not bloody
Non biliary
Contained food remnant
No abdominal distention
No urinary symptoms
No history of fever
Hematemesis: Rectorrhagia: -
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Drug history : Negative
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Past medical history:
History of cholecystectomy 20 years ago
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History of laparatomy due to bowel
obstruction 10 years ago
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History of similar symptoms 3 years ago
without operation
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Family history: Negative
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Old female, lying on the bed, ill but not toxic
BP: 100/75 PR: 110
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T: 37.2
RR: 16
Conjunctiva was not pale, sclera was not
icteric, JVP was not elevated
S4 was auscultated in heart examination
lungs were normal
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Abdominal examination :
 Fatty abdomen with midline laparatomic
scar and drain scar in RUQ
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Bowel sounds were hypoactive
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Generalized tenderness
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No guarding, no rebound tenderness
TR: Not bloody, No tenderness, Empty ampula
Hb
16.4
17.5
15
WBC
6600
6000
7800
neut
88%
84.3%
87.2%
Plt
222
204
142
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Na: 140.6 K: 3.71 BS: 189 Urea: 48
Cr:0.93
Amylase: 226.2
Ca:8.4
P:2.7
PT:15 PTT:40
INR:1.19
AST:61 ALT:94
ALP:134
U/A:
PH: 6 color: yellow Appearance: Clear
WBC: 2-3 RBC: 2-3 EP: 1-2
ABG:
PH:7.40 PCO2:27
HCO3:17.5
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Liver: normal
CBD: 16mm, dilation of intrahepatic biliary
ducts
Spleen and kidneys are normal
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WBC: 8200
HB:17.5
PLT: 75200
PTT: 36
PT: 19
INR: 1.6
U/A:
prt: 1+
blood: 3+
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AST: 44.9
ALT: 22
ALP: 113
ALB: 2.1
Amylase: 161
NA: 141
K: 5.4
Ca: 8
P: 4.3
BS: 74
Cr: 1.1
Urea: 54
CPK: 274
CPK-MB: 49
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WBC: 5400
HB:8.3
PLT: 30200
PTT: 40
PT: 20
INR: 2
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NA: 157
K: 3.8
Ca: 7.6
P: 3.2
BS: 123
Cr: 1.6
Urea: 63.2