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Case Conference

Case Conference. Resident Name, MD SVCH November 21, 2014. CC: Epigastric pain x 2-3 days. 51 yo AAM with PMH of DM, HTN, Smoker, Hypercholesterolemia. Hx of Present Illness. S ite  epigastric O nset  sudden, when he woke up C haracter sharp, 7/10 R adiation to the chest

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Case Conference

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  1. Case Conference Resident Name, MD SVCH November 21, 2014

  2. CC: Epigastric pain x 2-3 days • 51 yo AAM with PMH of DM, HTN, Smoker, Hypercholesterolemia

  3. Hx of Present Illness • Site epigastric • Onset sudden, when he woke up • Character sharp, 7/10 • Radiation to the chest • Alleviating factors none • Time course still present • Exacerb.factors movement • Sx SOB, DOE

  4. PMHx • HTN – on ACEi – not controlled • DM – on Insulin • Hypercholesterolemia – on Lipitor, LDL 134, HDL 34

  5. Medications • Insulin 70/30 – 30 U am, 10 U pm • Lipitor 10 qd • Zestril 10 qd • Isoptin SR 120 qd (Verapamil) • NKDA

  6. FMH, SH • Mother with HTN • Unemployed, lives alone • Heavy drinking in the past, quit 10 yr ago • Smoker – ½ ppd x 30 yrs • Cocaine, Heroin IV user 12 yrs ago

  7. Physical Examination • Appearance: • Thin man in NAD

  8. Physical Examination • Skin: no rash • HEENT: NC/AT • Chest: CTA (B) • Heart: Clear S1S2, regular • Abdomen: Soft, epigastric tenderness, 4-5 cm hepatomegaly, hard liver edge, +BS • Rectal: normal • Extremities: no c/c/e • Neuro exam: AAO x 3, no focal deficit

  9. Labs 16 PMN - 57 Bands – 17 Amylase 71, Lipase 235 Bil. – 1 AST - 158 Alb - 2.8 ALT - 238 INR - 1.11 AP – 364 CPP x 2 – negative 178 11 48 134 99 16 59 5 26 0.9 AG=9

  10. Further tests

  11. What would you do in this situation?

  12. What do you think ? • Diagnosis? • Differential diagnosis? • What tests to order? • Empiric therapy?

  13. What happened ?

  14. Outcome • Treated with IVF, Dopamine • HyperK+ corrected with D50 + Insulin, Kayexalate

  15. Final Diagnosis • Hepatocellular CA

  16. Take home message

  17. Any questions ?

  18. Literature Discussion

  19. Risk factors

  20. Etiology

  21. Symptoms

  22. Physical Exam

  23. Diagnosis

  24. Treatment

  25. Screening

  26. End • Click to go back to SVCH home page svch.blogspot.com

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