Question

A 36 years old Caucasian obese female presents to the ER with a complaint of epigastric pain for the last 2 days. The pain radiates through to her back, is constant, sharp in nature and reliever with sitting up. Associated symptoms include nausea and non bloody emesis. Eating makes the pain worse and therefore she has not eaten for the last 24 hours. She is married with 2 children. She denies any alcohol or drugs use. On exam she is afebrile, HR is 100, RR 22 and BP is 110/70mmhg. She is restless from the pain, diaphoretic and has icteric sclera. Heart and lung exam are unremarkable. Abdomen is soft with hypoactive bowel sounds and tender in the epigastric area and RUQ.
labs:
Sodium 140. potassium 3.0. Creatinine 1.0. BUN 20. WBC 12000, HCT 54. Hgb 18. Plt 200000. AST 70. ALT 75. Alkaline phosphatase 294. Total bilirubin 8.0. GGT 65. Lipase 1050.

1. what is the diagnosis?
2. what clinical scenario supports this diagnosis.?
3. what are the two common causes of the diagnosis?
4. for what actual or potential complications related to the diagnosis does she need to be monitored?
5. Why is K value abnormal?What do the abnormal GGT and Alkaline phosphate indicate?Why are the lipase and bilirubin elevated?

Answer 1

1, Abdominal Aortic Aneurysm. It is an enlarged area in the lower part of the major vessel that supplies blood to the aorta.
2, Epigastric Pain, pain radiating to back, pain relieve with sitting up, nausea, high heart rate, diaphoretic, icteric sclera, RUQ tenderness.
3, Obesity and Caucasian ethnicity(white) are the two common causes of the diagnosis.
4, Rupture Aneurysm and liver failure are the potential complications need to be monitored. platelet count, AST, ALT abnormalities, increased Toal bilirubin, GGT, lipase indicates there is a chance for bleeding aneurysm and liver failure.