tommyk
05-20-2006, 04:40 AM
Hy 2221
A 15-year-old Indian boy in the US is brought to the emergency room because of persistent midepigastric pain for two days. The pain is getting no better, yet it is no worse, and radiates to his back. The boy also has had fever, as well as nausea and vomiting that is worse when his temperature rises in the afternoon. On examination, his temperature is 39.5 C (102.7 F) and there is marked upper abdominal tenderness with guarding. Mild abdominal distention is present with no audible bowel sounds. A complete blood count reveals an elevated leukocyte count and a normal serum amylase. He is a moderate EtOH drinker. Which of the following is the most likely diagnosis?
1-Intussupation
2-Pancreatitis
3-Trauma
4-Wilm’s Tumor
5-Pylonephritis
6-Herniated disk
7-Fitz-Curtis Syn
ans) Pancreatitis….Pancreatitis is not always an easy diagnosis. The history of this boy is particularly suspect, even with a normal serum amylase. Nearly one-third of all patients with acute pancreatitis have a normal serum amylase. An abdominal ultrasound may be useful in revealing an enlarged pancreas. This young man is unlikely to have Fitz-Hugh-Curtis syndrome. Classically, Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of pelvic inflammatory disease in sexually active women. It is a perihepatitis consisting of adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface. It was originally thought to be caused solely by Neisseria gonorrhoeae, but recent studies have shown that Chlamydia trachomatis and other organisms may also be etiologies. Please be careful who you have “relations” with…hopefully it will be only one in your lifetime…your spouse. The Fitz-Hugh-Curtis syndrome has rarely been reported in men, so a sexual history should be obtained in this case. Intussusception is not high on the list of differential diagnoses. The typical age for intussusception is in infancy, especially 6 to 12 months of age. This young man has persistent abdominal pain with fever, making this an unlikely diagnosis. Wilms tumor is also unlikely in this case scenario. Wilms tumor usually occurs in early childhood, age 2 or 3 years. Although Wilms tumor is more prevalent in males, the usual presenting signs include an asymptomatic abdominal mass and hematuria. Pyelonephritis typically presents with high fever, chills, and back pain. Although a urinalysis should be performed in this young man, the symptoms of midepigastric pain suggest an upper gastrointestinal problem, not pyelonephritis. Hard question, did you get it?
A 15-year-old Indian boy in the US is brought to the emergency room because of persistent midepigastric pain for two days. The pain is getting no better, yet it is no worse, and radiates to his back. The boy also has had fever, as well as nausea and vomiting that is worse when his temperature rises in the afternoon. On examination, his temperature is 39.5 C (102.7 F) and there is marked upper abdominal tenderness with guarding. Mild abdominal distention is present with no audible bowel sounds. A complete blood count reveals an elevated leukocyte count and a normal serum amylase. He is a moderate EtOH drinker. Which of the following is the most likely diagnosis?
1-Intussupation
2-Pancreatitis
3-Trauma
4-Wilm’s Tumor
5-Pylonephritis
6-Herniated disk
7-Fitz-Curtis Syn
ans) Pancreatitis….Pancreatitis is not always an easy diagnosis. The history of this boy is particularly suspect, even with a normal serum amylase. Nearly one-third of all patients with acute pancreatitis have a normal serum amylase. An abdominal ultrasound may be useful in revealing an enlarged pancreas. This young man is unlikely to have Fitz-Hugh-Curtis syndrome. Classically, Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of pelvic inflammatory disease in sexually active women. It is a perihepatitis consisting of adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface. It was originally thought to be caused solely by Neisseria gonorrhoeae, but recent studies have shown that Chlamydia trachomatis and other organisms may also be etiologies. Please be careful who you have “relations” with…hopefully it will be only one in your lifetime…your spouse. The Fitz-Hugh-Curtis syndrome has rarely been reported in men, so a sexual history should be obtained in this case. Intussusception is not high on the list of differential diagnoses. The typical age for intussusception is in infancy, especially 6 to 12 months of age. This young man has persistent abdominal pain with fever, making this an unlikely diagnosis. Wilms tumor is also unlikely in this case scenario. Wilms tumor usually occurs in early childhood, age 2 or 3 years. Although Wilms tumor is more prevalent in males, the usual presenting signs include an asymptomatic abdominal mass and hematuria. Pyelonephritis typically presents with high fever, chills, and back pain. Although a urinalysis should be performed in this young man, the symptoms of midepigastric pain suggest an upper gastrointestinal problem, not pyelonephritis. Hard question, did you get it?