A previously well 38 yo man presents with a week of worsening vomiting, diarrhoea and abdominal pain. On the day of presentation to the ED he has become drowsy and confused.
T 37 degrees Celsius
PR 110/min
BP 120/80 mmHg
GCS 12 (E3,V4,M5)
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A previously well 38 yo man presents with a week of worsening vomiting, diarrhoea and abdominal pain. On the day of presentation to the ED he has become drowsy and confused.
T 37 degrees Celsius
PR 110/min
BP 120/80 mmHg
GCS 12 (E3,V4,M5)
67 year old man presents 7 days post major surgery critically unwell. He has severe sepsis (high temp, compensated shock).
39 year old female presents with vomiting, diarrhoea and upper abdominal pain.
Vitals:
BP 100/60
PR 45/min
RR 20/min
T 36
Describe and Interpret Continue reading
The bloods show a mild neutrophilia and substantially deranged liver functions tests. She has jaundice, confirmed biochemically and the pattern of LFT derangement with all of the ALP, ALT and GGT elevated is a mixed one (suggesting both hepatitic and obstructive changes)
The most likely diagnosis given the clinical context is ascending cholangitis due to an obstruction of the lower biliary tract. The most likely aetiology is a gallstone. Another important cause is a tumour involving the biliary tract or pancreas.
This patient has a life threatening emergency.
Her priorities in ED;
It is essential that her ongoing management be in a centre that can perform an ERCP as relief of her biliary obstruction is critical in resolution of the illness. The severity of such a presentation should not be underestimated. There is a significant mortality.