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ID : 53 years old female CC : Abdominal Pain

ID : 53 years old female CC : Abdominal Pain. PRESENT ILLNESS:. 53 years old female Abdominal pain since three days ago generalized Constant Without radiation Not related to the patient’s position No relation to meals

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ID : 53 years old female CC : Abdominal Pain

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  1. ID : 53 years old female • CC : Abdominal Pain

  2. PRESENT ILLNESS: 53 years old female Abdominal pain since three days ago generalized Constant Without radiation Not related to the patient’s position No relation to meals Anorexia: + Last defecation: 2 days ago Gas passage : -

  3. PRESENT ILLNESS: Vomiting : + Not bloody Non biliary Contained food remnant No abdominal distention No urinary symptoms No history of fever Hematemesis: - Rectorrhagia: -

  4. Drug history : Negative • Past medical history: • History of cholecystectomy 20 years ago • History of laparatomy due to bowel obstruction 10 years ago • History of similar symptoms 3 years ago without operation • Family history: Negative

  5. PHYSICAL EXAMINATION: • Old female, lying on the bed, ill but not toxic BP: 100/75 PR: 110 T: 37.2 RR: 16 • Conjunctiva was not pale, sclera was not icteric, JVP was not elevated • S4 was auscultated in heart examination • lungs were normal

  6. PHYSICAL EXAMINATION: • Abdominal examination : • Fatty abdomen with midline laparatomic scar and drain scar in RUQ • Bowel sounds were hypoactive • Generalized tenderness • No guarding, no rebound tenderness • TR: Not bloody, No tenderness, Empty ampula

  7. LAB DATA:

  8. LAB DATA: • Na: 140.6 K: 3.71 BS: 189 Urea: 48 Cr:0.93 • Amylase: 226.2 Ca:8.4 P:2.7 • PT:15 PTT:40 INR:1.19 • AST:61 ALT:94 ALP:134 • U/A: PH: 6 color: yellow Appearance: Clear WBC: 2-3 RBC: 2-3 EP: 1-2 • ABG: PH:7.40 PCO2:27 HCO3:17.5

  9. Sonography: • Liver: normal • CBD: 16mm, dilation of intrahepaticbiliary ducts • Spleen and kidneys are normal

  10. Lab data after 1st surgery • WBC: 8200 • HB:17.5 • PLT: 75200 • PTT: 36 • PT: 19 • INR: 1.6 • U/A: prt: 1+ blood: 3+ • AST: 44.9 • ALT: 22 • ALP: 113 • ALB: 2.1 • Amylase: 161 • NA: 141 • K: 5.4 • Ca: 8 • P: 4.3 • BS: 74 • Cr: 1.1 • Urea: 54 • CPK: 274 • CPK-MB: 49

  11. Lab data after 2nd surgery • WBC: 5400 • HB:8.3 • PLT: 30200 • PTT: 40 • PT: 20 • INR: 2 • NA: 157 • K: 3.8 • Ca: 7.6 • P: 3.2 • BS: 123 • Cr: 1.6 • Urea: 63.2

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