PPT-55yo obese woman with presents with severe epigastric pain. Afebrile, WBC 15, normal LFTs.

What is your overall interpretation and clinical diagnosis Images courtesy of Brandon Fainstad MD Gallstones at bladder neck with sludge and a thickened GB wall Acute Cholecystitis What is a normal GB wall thickness and when does a thickened GB not suggest cholecystitis . An 11-year old male is brought to the ER 30 minutes after sustaining a stab wound at the epigastric area during a street rumble. . Epigastric Stab Wounds. At the Emergency Room: . He . is conversant, conscious, coherent, ambulatory, not in respiratory distress . Sharon Case. May. 2012. Intake. Female age 29. First visit: May 16, 2012. Occupation: Farmer. Main Complaints: . Joint pain and popping. Head, neck, shoulder pain. Migraines. Daily digestive upset – cramping, bloating, irregular bowels. Simon . Lynes. Definition. Progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. Aetiology. Vascular – Budd . Chiari. Infectious – viral hepatitis B and C. PGY-II. Sinai-Grace Emergency Medicine. Disclosures. None. Caries. Oral flora develop “Dental Bacterial Plaque”. Metabolize carbohydrates .  acids  Erode enamel . After enamel eroded .  Microporous dentin  Pulp. 2014. Case # 7. 63 yr old left handed female presents with progressive headache, left homonymous hemianopia and left hemiparesis.. PMH: HTN, DM, breast cancer 12 years earlier with negative follow up. Stephen B. Disclaimer. While this talk is as accurate as . we could . make it, . we are students. . Accordingly, there may be errors. Please do not rely on this talk when making clinical decisions. The AMSS and authors of this talk do not accept any responsibility or liability relating to the use of the information.. Kevin . Biese, . MD, MAT. Ellen Roberts, . PhD, MPH. Jan Busby-Whitehead, MD. University . of North Carolina . at . Chapel Hill. Division of Geriatric Medicine. Center for Aging and Health . Department of Emergency Medicine. 1 minute per question. WRITE DOWN YOUR ANSWERS. Try not to confer or look up answers. Question 1. A 30 year old banker came in with pain in the . epigastric. region which radiated to his back. He says he can't keep anything down & sitting forward helps. On examination there is decreased breath sounds on the left side which is stony dull to percussion at the base. Which of these investigations is most appropriate? . Bashagard. & live in . Bandarabas. SOH: . Own patient who was C.R.I. CC: . Hemoptysis. PI. : . The patient is a 51-year-old . man, Opium Addict, . who referred to the center with a complaint of Hemoptysis 3 days ago and 2 times . HPI. Patient is 30 . yo. old G6P4013 at 36+5 is here in clinic with concerns for weight gain, intermittent headaches/epigastric discomfort, nausea and increased swelling. . More history. Symptoms started together approximately 1 week ago and per patient has gained approximately 15 pounds. . Nicole López-. Cañizares. MD. 1. , . Cristhian. Valor MD. 2. , Flavio . Malcher. MD, MSc, FACS. 3. . Department of Surgery, NYU Langone Hospital. DISCLOSURES . FM: Intuitive, BD, Medtronic, Integra, Allergan, Deep Blue. A 60-year-old man presents to the emergency department with 1 day history of hematemesis and melena. He has a history of osteoarthritis, diabetes mellitus, and hypertension. He has a remote history of hepatitis C, which was treated successfully in the 1990s. His medications include metformin, glimepiride, aspirin 81 mg, and ibuprofen 400 mg three times daily. On physical examination, his vital signs are as follows: Temperature 36° C Blood pressure 90/55 mm Hg Heart rate 110 bpm Respiratory rate 12 breaths/min His abdominal exam is soft and nontender. Laboratory studies are as follows: Hemoglobin 7.5 g/dL WBC 6000/μL Platelet count 290,000/μL Total bilirubin 1.4 mg/dL Creatinine 1.2 mg/dL INR 1.8 Which of the following recommendations is correct for this patient’s management?. Pain was generalized at first, now worse in right lower abd & radiates to his right groin. . Vomited X2 . No appetite today. . ROS otherwise negative.. Physical exam:. T: 37.8, HR: 95, BP 118/76, R: 18, O2 sat: 100%. Due to premature activation of pancreatic enzymes within the pancreas, leading to a process of . autodigestion. . . Anything that injures the . acinar. cell and impairs the secretion of zymogen granules, or damages the duct epithelium and thus delays enzymatic secretion, can trigger acute pancreatitis. Once cellular injury has been initiated, the inflammatory process can lead to pancreatic .