Hey guys, and welcome back to Diagnose This! This definitely, 100% counts as studying so don’t feel guilty for using our fantastic blog for guilt-free procrastination. Or use it for fun. Whatever tickles your pickles ladies and gentlemen.
Now, in celebration of St Patrick’s Day we had a very interesting case of what can (and often does) happen when one celebrates a little too hard and has just a wee bit more of the green-coloured beer than they intended. Hopefully you all picked up that this was a case of acute pancreatitis; the hallmark bruising on the flanks and around the umbilicus, the pain radiating to the back, and the history of acute alcohol abuse all point towards this nasty and quite painful condition. Next, the tests to be performed would be the obvious checks for vitals and an examination. More specifically, the serum amylase and lipase should be checked (the former being three times the upper limit of normal and the latter elevated), as well as the general LFTs and FBC (ALT/AST 3x upper limit, FBC showing potential leukocytosis), an ECG to rule out cardiac cause, and an AXR to see any calcifications or other GIT-related conditions. Finally, the handy mnemonic is I GET SMASHED which is oddly relevant to last week’s case! It stands for: Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps/malignancy, Autoimmune, Scorpion stings/spider bites, Hyperlipidaemia/hypercalcaemia, ERCP, Drugs. The first four of this list are the most common and the most important to remember; the others can be used at dinner parties or in trivial pursuit as fun little facts.
Hope it all went well! Now onto the next case:
A 47 year old male is brought to the emergency department after a fight at the local pub. He is known to hospital staff as a chronic alcoholic, drinking upwards of 10 standards every day for the past 20 years, as well as a history of chronic abuse of amphetamines. Upon examination he appears irritable and cannot stand up, slurring his words and making a general nuisance of himself. You are about to dismiss this as the symptoms of being drunk when he loses consciousness and begins to seize. You notice that his vitals are dropping rapidly and his condition is deteriorating.
Based off this history, what is your main concerning differential? How would you stabilise this patient and bring him back from the brink of death? What tests would you like to perform for this patient to confirm your diagnosis, and what classic sign will be seen on a CT?
Tune in next week to see how you well you did, and good luck!
Approximately 40% of all ED admissions can be attributed to alcohol misuse, either directly or indirectly. Please don’t end up a statistic and drink responsibly friends.
Image credit: http://www.slideshare.net/jameswheeler001/amphetamine-toxicity