You are still working at Emergency and today you're in a great mood to solve some real though case. obviously inspired by House, M.D's latest episode you watched last night .That's exactly when an 81-year-old female presents to the you complaining of one day of intermittent, diffuse abdominal pain with a medical history of coronary artery disease, remote history of coronary bypass surgery, and successful endovascular stent placement for abdominal aortic aneurysm (AAA) three months earlier. The patient denied associated nausea or vomiting, fevers, dysuria, chest pain or shortness of breath. She reported a normal bowel movement earlier in the day without blood or black stool. Her episodes of abdominal pain were reported to occur approximately every 20 minutes, with complete resolution of her pain between episodes. The patient had undergone an abdominal CT one month earlier, which demonstrated a stable AAA with stent in place.this coming and going of pain quite baffled you up but before getting totally freaked out you knew one last thing to do , you performed PE :
GENERALAPPEARANCE: An elderly female who
appeared well hydrated and in no acute discomfort.
VITAL SIGNS
Temperature 98.1 F(36.7 C)
Pulse 76 beats per minute
Blood pressure 128/60 mmHg
Respirations 16 breathsper minute
Oxygen saturation 97% onroom air
Head Eyes & ENT: PERRL, EOMI, no scleral icterus, oropharynx pink and moist.
NECK: Smooth, no jugular venousdistension.
CARDIOVASCULAR: Regular rate and rhythm without rubs, murmurs or gallops.
LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Soft,mildly distended with increased tympany and hypoactive bowel sounds present.Nontender without a pulsatile mass.
RECTAL: Normal tone, soft,brown stool,hemoccult negative.
EXTREMITIES: Well perfused without clubbing, cyanosis or edema.
NEUROLOGIC: Nonfocal.
You palced an IV line, blood was drawn and sent for laboratory testing. Laboratory tests, including a complete blood count, electrolytes, creatinine, glucose, serum lactate and urinalysis, were all within normal limits. During the patient’s stay, she was observed to have several intermittent bouts of severe abdominal pain,occurring approximately every 30 minutes.
You get a brain wave and a CT of abdomen & pelvis with oral and intravenous contrast is obtained
(figure given).
Now what's your diagnosis?
How do you think you're going to treat this wonderful old lady?
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