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COLECISTO-PANCREATITA CU VSH 107 mm/hCaz clinicProbleme de diagnosticAndritoiu AlexandruSp. Militar Craiova
T. Valeria, 86 ani09/12/2103 CPUMotivele prezentarii:Dureri abdominale (etaj superior)InapetentaVarsaturiBalonari
DEBUT DE APROX. 2 SAPT.
ClinicAbdomen:Moderat destins, sensibil in etajul superiorObezitate moderataTip picnic
Afebrila
ParacliniceECG: RS, FC 100/min, Ax QRS +5, repolarizare normalaEcho Abdominala:Colecist cu perete ingrosat, difuz edematiat, fara calculi. Aerocolie generalizata.In obs. Colecistita subac. nelitiazica
CT abdomen
Ex. BiologiceVSH 107mm/h
TratamentSULCEF 2 X 2 g/zi (I.V.)TRIFERMENT 3 X1 dg/ziGASEX 3 x 1 cp/ziOMEPRAZOL 2o mg/ziSILIMARINA 2 x1 cp/zi
EvolutieClinic: favorabila (digestiv)afebrilaEcho Abd: Colecist cu perete suplu. Fara colectii intra-abdominaleBiologic: Reducerea amilazemiei si citolizei hepaticeVSH redus, dar totusi inexplicabil de mare!
Ex. BiologiceVSH 52 mm/hVSH 107mm/hSulcef 4 g I.V.
Probleme de diagnosticColecistita acuta gangrenoasa?Plastron colecistic?Abces hepatic?Colectii peri-pancreatice abcedate?Neoplazie?
Reluare anamneza /ex. clinicLa debut: inj. I.M. cu Algifen (cadran fesier super. bilateral)Local: tegumente infiltrate, zona indurata, hiperemica (flegmon fesier bilateral?)Recomandare: Consult chirurgicalEcho-parti moi (reg. fesiera)
Echo reg. fesiera
Consult chirurgicalDiagnostic:Flegmon fesier drept
Anestezie locala cu Xilina 1%-30 mLIncizie, evacuare (puroi brun-galbui, aprox. 200 mL)Toaleta cu H2O2, ser fiziologic, betadinaMesaj hemostatic Pansament localDr. Ungureanu Gheorghe
MesajEx. clinic amanuntit si reluarea anamnezei (detaliata) pot fi revelatoare de diagnostic in cazurile ,,atipice,,