epigastric pain

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epigastric pain

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arbaz
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07/11/06 - 02:45 PM

A 72 year old woman present with pain in abdomen for 3 days the pain is started in the epigastrium and then it become diffuse pain is moderate in intensity she also complain of nausea indigestion and constipation there is no rebound tenderness and she is diabetic and takes opoid analgesics for joint pain ?what is her likely condition

a appendicitis
b cholecystitis
c pancreatitis
d duodenal ulcer
e gastroenteritis

arbaz
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07/11/06 - 02:48 PM

give ur suggestions

muzammil
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07/11/06 - 02:49 PM

with the given scnerio i wud go for ulcer

study_ing
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07/11/06 - 02:50 PM

D

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study_ing
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07/11/06 - 02:50 PM

epigastric pain think of foregut structure

nsaid use favors duodenum over chole

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star1
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07/11/06 - 03:00 PM

itS b CHOLYCYSTITIS.. due to opoid analgesic there is billiary colic that produces these symptoms..

muzammil
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07/11/06 - 03:03 PM

plz explain abit star 1

star1
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07/11/06 - 03:28 PM

THe point that give me clue to cholycystitis is opioid analgesics...

they increase biliary muscle tone so may lead to cholecystitis....

But I m unable to exclude D ... as pain is in epigastrium

a appendicitis ( is not common in that age group)
b cholecystitis
c pancreatitis
d duodenal ulcer
e gastroenteritis

anybody help us

Cedrick
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07/11/06 - 03:31 PM

Pancreas

c.-pancreatitis

guangyu
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07/11/06 - 04:26 PM

#10

docofthebigapple
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07/11/06 - 05:02 PM

#11

opoids can cause spasm of sphinctor of oddi. this will prevent release of bile into the duodenum. obstruction of release of pancreatic juices from the sphinctor can also cause pancreatitis.

Why pain is not going in the back?

She is a diabetic and has sensory neuropathy.

arbaz
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07/11/06 - 08:31 PM

#12

its cholecystitis as there is no relation of food with it and no heart burn so cant be duodenal ulcer and choleystitis pain in many patients start in epigastric region and thenbecom diffused opoids r another clue and in diabetics there is increased risk of cholecystitis .so i think answer is B

MRMAVERICK
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07/12/06 - 03:24 AM

#13

cholecystitis
i thnk its a real case
right mr arbaz

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docsrinu
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08/30/06 - 11:04 AM

#14

arbaz u posted "i think answer is b". don't u know the correct answer?

arbaz wrote:
its cholecystitis as there is no relation of food with it and no heart burn so cant be duodenal ulcer and choleystitis pain in many patients start in epigastric region and thenbecom diffused opoids r another clue and in diabetics there is increased risk of cholecystitis .sanswer is B

o i think

fox
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08/30/06 - 02:05 PM

#15

I feel A appendicitis could be a strong contender bcos, in appendicitis, pain starts in the epigastric region & then becomes diffuse. Rebound tenderness could be masked as she is already takin opiod analgesics.

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ManuNastai

08/31/06 - 01:34 AM

#16

B

It's not apendicitis because doesn't have the tippical pain that goes from the epigastric region to the iliac fosa and there isn't vomiting involved.. no fever..

An acute pancreatitis secondary to a spasm on Oddi due to opioid use it's possible, but should be more violent clinically

Remember: ulcer=must have pain, even if it's a diabetic. Ulcers are very painfull stuff, PERIODICAL pain!!!

For gastroenteritis doesn't have the vomiting and the diarhea

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