Question

Female, 60 years old, with abdominal pain for 2 days.After 2 days' advance of eating greasy food, the pain in the midsection of the upper abdomen was gradually increased, and it gradually became persistent. It radiated to the lower back, and became worse when lying on the back, coughing, or exercising. The abdominal pain was not relieved, and repeated use of analgesics was ineffective. No symptoms of cough, chest pain, diarrhea and urination since the onset. He has had cholelithiasis for many years, but has no history of chronic upper abdominal pain, no history of acid reflux, black stools, no clear history of heart, lung, liver, kidney disease, and no special records of personal history and family history.

Examination: T39°C, P104 beats/min, R19 beats/min, Bp130/80mmHg, laterally curled position of acute disease, dry skin, no bleeding spots, no superficial lymph nodes untouched, no sclera yellow staining, no abnormalities of the heart and lungs, abdominal Flat, mild muscle tension in the upper abdomen, obvious tenderness, suspicious rebound pain, no mass touched, negative Murphy sign, no obvious percussion pain in the liver and kidney area, suspicious positive mobile dullness, slightly bowel sounds, and lower limbs not swollen .

Laboratory tests: blood Hb120g/L, WBC 22×109/L, N86%, L14%, plt 110×109/L. Urine protein (±), RBC 2-3/high power, urine amylase 32U, abdominal plain film not seen free gas and fluid level under the diaphragm, slightly expanded intestinal tract, serum BUN 7.0 mmol/L.

1. Diagnosis and diagnosis basis

2. Differential diagnosis

3. Further inspection

4. Treatment principles

In clinic，how to diagnose the progressive hemothorax

Answer 1

Upper midsextiof abdomen composed of part of liver and pancreas.

1. Based on given physical examination findings and lab investigations done to patient the patient condition suspect as pancreatitis.

2. Differential diagnosis help to identify or distinguish other diseases which have same clinical symptoms. Hear serum amylase level helps as differential diagnosis ,in kidney problems amylase levels remaining normal.In liver diseases liver enzymes elevate and cause diabetes too. And pain in upper abdomen and radiation to back present in pancreatitis only.

3. Further inspection need to do ,ultrasound abdomen, serum lipase. Assess for personal habits of smoking and alcoholism. These will help us to investigate furthermore.Investigate for presence of any infections.

4.Treatment principles of pancreatitis *Early aggressive fluid resuscitation. *intensive care with close monitor. *Antibiotics prophylaxis. *Early supportive treatment of organ failure. *Surgery in infected pancreatitis.

Hemothorax is an accumulation of blood with in the pleural cavity . It is presented with clinical signs chest pain,difficulty in breathing,reduced breath sounds on affected side,rapid heart rate. Causes for hemothorax are an injury to chest wall, cancer invading the pleural cavity, blood clotting disorders. Clinical diagnosis is done by clinical symptoms and reported medical problems by the patient. *During physical examination we will hear abnormal breathing sounds. *On percussion of chest we will feel the sounds of fluid accumulation. By these methods clinical diagnosis of hemothorax done.