Even More Pain

Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This elderly gentleman has presented with an acute abdomen, one of the most concerning presentations in this age group. Statistics show that almost 50% of such individuals eventually require hospital admission, and between 20% to 33%, immediate surgery.\n\nWhen faced with an acute abdomen, the first and most important diagnostic clue is the location of the pain; in this patient, the localization to the left upper quadrant suggests at either a cardiac, gastric, pancreatic, renal, or vascular etiology.\n\nThe abrupt onset of the pain is another potent clue; an acute coronary syndrome could present in this manner, as could vascular catastrophes such as mesenteric ischemia, abdominal aortic dissection, or renal infarction. Other key possibilities include perforation of a peptic ulcer, and ureteric colic.\n\nExamination reveals tenderness in the left upper quadrant; this is too nonspecific a sign to be of much help. However, he also has an irregularly irregular pulse, suggesting at atrial fibrill"}]}

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