G’day guys, and welcome back to Diagnose This! We here at bloodbonesandbodies hope that your week was fantastic, fruitful, and full of learning, and that you are all ready to acquire some more medical based knowledge today!
So, last week we had the case of the man with the abdominal pain; an incredibly common and sometimes ominous symptom that can be anything from muscular to cancer. The preliminary diagnosis for this gentleman is diverticulitis; although most people discover they have diverticulosis as an incidental finding during colonoscopy there are some whose first presentation is the painful and often worrying diverticulitis. A CT scan is the recommended next step in both clinching the diagnosis and discovering the extent/severity of disease. Immediate management for this patient would be admission into the hospital, with IV antibiotics (such as piperacillin and tazobactam to combat the gram-negative anaerobic bacteria) and fluid resuscitation, although these measures are usually only reserved for moderate-severe diverticulitis with inpatient admission. A colonoscopy should be performed 4-6 weeks after discharge from hospital, both to ensure there are no complications arising from the diverticulitis and also due to the patient’s age.
Hopefully you were all correct and are patting yourselves on the back now! If not, don’t stress; medicine is a hard gig and we all screw up once in awhile :).
So, now onto the next case!
A 20 year old male presents to the ED via ambulance with chest pain and SOB. The pain is sharp and stabbing in nature and is a 9/10, with the pain being worse on inspiration and better when leaning forward. His hs-cTn levels (high sensitivity cardiac troponin) were 2.7ng/L. An ECG is performed and the following strip is obtained:
What is your preliminary diagnosis? What other investigations would need to be performed? What is the treatment/management of this patient?
Tune in next week to find out!
Picture courtesy of Life in the Fast Lane: http://lifeinthefastlane.com/