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Case Conference

Case Conference. 2007.7.24 By intern 李凱靈. Patient ’ s Profile. Name: 孫 x 欣 Age: 21 year-old Sex: female Date of admission: 11-July-2007 Time: 8.23pm Triage: P3. Status on Arrival. E4V5M6 RR:20/min BP:149/128 Temp: 37.7 ’ C Pulse:57/min. Chief Complain.

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Case Conference

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  1. Case Conference 2007.7.24 By intern 李凱靈

  2. Patient’s Profile • Name: 孫x欣 • Age: 21 year-old • Sex: female • Date of admission: 11-July-2007 • Time: 8.23pm • Triage: P3

  3. Status on Arrival • E4V5M6 • RR:20/min • BP:149/128 • Temp: 37.7’C • Pulse:57/min

  4. Chief Complain • Low abdominal pain shifted to RUQ and right flank for 2-3 days.

  5. Present illness • Low abdominal pain shifted to RUQ and right flank • Associated symptoms: • Urination: Dysuria (+), Burning sensation (+) • Fever(+) • Constipation(+) • Nausea(-)

  6. Past history • Drug allergy :denied • Diabetes mellitus :denied • Hypertension:denied • Asthma:denied • LMP: 2007.7.9

  7. Physical examination • Right flank knocking pain (+)

  8. Lab Data • 7/11 7/12

  9. Initial Clinical Impression • Suspect APN • R/O intra abdominal abscess Plan • Arrange abdominal CT with enhancement • Pain control • Antibiotics use (Avelox) for infection control

  10. Uro consultation 7/12 01.47 am • RLQ pain radiated to periumbilical area • PE: no right flank knocking pain • Echo: no obvious right hydronephrosis • Assessment: Right APN unlikely • Suggest: consult GYN (r/o PID)

  11. Image Finding

  12. Clinical impression(2) • Suspect an abscess or a hemorrhagic lesion in the right renal parenchyma. • Superimposed neoplasms cannot be excluded.

  13. GS consultation • 7/12 11:10am • Pain area (RLQ)not compatible with CT finding r/o other possible causes • No other associated problems over GI tract • Suggest : contact uro

  14. GYN consultation • 7/12 13.46 pm • Sex behaviour (+) • Sono: NGL • PV:Cervix motion tenderness (-), bilateral adnexa tenderness • PE: right flank pain. Lower abdominal tenderness(-) • Assessment: no OBY/GYN emergency • Suggest: contact uro

  15. Final plan • Admit to Uro ward for further management. • Uro clinical impression: Right renal abscess

  16. The End! • Thank you Very Much for your kind attention!

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