Case Gen 3

S.Wichien 17/6/2554

Patient identification
‡ ‡ ‡ ‡ 33 .

History
‡ CC : . ‡ PI : 6 6
. . .

2 3
. .

History
‡ ‡ ‡ ‡ 8 10

Physical examination
‡ BT 38.2 c, PR 110, RR 24, BP 140/90 ‡ HEENT
± Pink conjunctivae, Mild jaundice ± CLN : impalpable

‡ Heart
± Normal S1 S2, no murmur

‡ Lung
± Normal breath sound

Physical examination
‡ Abdomen
-Mild distended abdomen -Tender as figured -No guarding -No mass -Decreased bowel sound -Surgical scar as figured

Physical examination
‡ Extremity
± No pitting edema

‡ PR
± Mild warmness ± Yellowish soft feces ± No mass ± No rectal shelf

Physical examination
‡ Sign of chronic liver disease
± Parotid gland enlargement ± Spider naevi +ve ± Palmar erythema

Lab
‡ CBC
± HB 11, Hct 36.1, WBC 5200 ± PMN 86% ± Plt 109,000

Lab
‡ LFT
± Chol 175, TP 8.6, alb 4.5, glob 4.8 ± TB 4.8, DB 2.4 ± ALT 55, AST 130, ALP 243

‡ HBV/HCV = -ve

Lab
‡ UA
± Sp.gr 1.024, WBC 5-10, RBC 5-10

‡ BUN 8.6 / Cr 0.8

Ultrasound bedside
‡ ‡ ‡ ‡ No IHD dilatation Collapsed gall bladder Small gall stones Minimal ascites

Lab
‡ Serum Amylase 57 ‡ Urine amylase 222

Admit day 1
‡ ‡ ‡ H/C = gram negative bacilli *2 specimen

Follow up

CT abdomen

Management
‡ Pre op Dx
± Acute appendicitis ± Alcoholic cirrhosis

Thank you