mash
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A 29-year-old G3P2 black woman in the thirty-third week of gestation is admitted to the emergency room because of acute abdominal pain that has been increasing during the past 24 h. The pain is severe and is radiating from the epigastrium to the back. The patient has vomited a few times and has not eaten or had a bowel movement since the pain started. On examination, you observe an acutely ill patient lying on the bed with her knees drawn up. Her blood pressure is 150/100 mmHg, her pulse is 110/min, and her temperature is 38.8°C (100.8°F). On palpation, the abdomen is somewhat distended and tender, mainly in the epigastric area, and the uterine fundus reaches 31 cm above the symphysis. Hypotonic bowel sounds are noted. Fetal monitoring reveals a normal pattern of fetal heart rate (FHR) without uterine contractions. On ultrasonography, the fetus is in vertex presentation and appropriate in size for gestational age; fetal breathing and trunk movements are noted, and the volume of amniotic fluid is normal. The placenta is located on the anterior uterine wall and of grade 2 to 3. Laboratory values show mild leukocytosis (12,000 cells per L); a hematocrit of 43; mildly elevated serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), and bilirubin; and serum amylase of 180 U/dL. Urinalysis is normal. Which of the following is the most likely diagnosis?
A. Acute degeneration of uterine leiomyoma
B. Acute cholecystitis
C. Acute pancreatitis
D. Acute appendicitis
E. Severe preeclamptic toxemia
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| mani
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D. Acute appendicitis
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| bluesky
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E. Severe preeclamptic toxemia.
Her blood pressure is 150/100 mmHg
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| chemamr
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Itīs E.  , epigastric/RUQ pain with elevated transaminases.
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| ayeshah_l
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in pre-eclampsia there should be proteinuria, her U/A is normal. I think its appendicitis.
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| chemamr
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in appendicitis, TGO, TGP are normal, pain is not epigastric
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| ayeshah_l
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but she is pregnant!! so atypical presentation??
besides severe preeclampsia without proteinuria??? and BP less than 160/110!!!
Edited by ayeshah_l on 06/14/05 - 06:05 PM
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| rubyedward
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its accut appenticitis, with typical presentation in preg cuz appentiz's pushed upward by growing uterus. we may see mildly elevated liver enzymes. it cann't be preeclampsia like ayeshah mentioned.
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| ayeshah_l
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hey guys, i found the correct answer to the above q. Its C.. acute pancreatitis.
A. LFT's are normal
B. May have fever, leukocytosis and pain in right upper quad. with abnormal LFT's but amylase will me mildly elevated ..if at all and pain would be less severe than describe in this patient.
C. Predisposing factors: Cholelithiasis, chr. aldoholism, infection, abd.trauma, some meds. and preg. induced hypertension!!
classic findings: person who is rocking with knees drawn up and trunk flexed in agony. Fever, tachypnea hypotension, ascites and pleural effusion may be observed. Hypotonic bowel sounds epigastric tenderness, signs of peritonitis maybe present. Leukocytosis, hemoconc. and ab. LFTs are common findings. Most imp. finding is elevated s. amylase. which appear 12 to 24 hrs after the onset of clinical disease. and values may exceed 200 U/dL (N= 50 -160 U/dL )
Managment is same as in nonpreg. patient. IV hydration, NG suction, enteric rest, and correction of electrolyte imbalance and hyperglycemia. Careful attention to tissue perfusion vol.expansion and tranfusions to maintain a stable cardiovascular performance are critical. Gradual recovery occurs over 5-6 days
D. Sym. are same as in nonpreg. pt but pain is more vague and poorly localized and the point of max. tenderness moves with advancing gestation to the right upper quadrant. LFT's are normal !!!!
E. May have disturbed liver function tests with HELLP synd. but this pt. has only mild elevation of BP and no proteinuria
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