Seeping
Gastrointestinal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S15_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022\u0027Twas the day after Christmas and all through the hospital\n Not a creature was stirring, not even a\u2026\u0022\n\n.... you stop humming.\n\n\u0022Now what rhymes with \u0027hospital\u0027?\u0022 you wonder.\n\nHowever, you do not get a chance to figure this out.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S15_F2.jpg"}},{"insert":"\n\n"},{"insert":"A nurse interrupts your little reverie with the information that one of your post-op patients, Mrs. Williams, is running a fever of 103\u02daF (39.4\u02daC) and is also complaining of abdominal pain.\n\nShe has already been given Acetaminophen (Paracetamol).\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S15_F3.jpg"}},{"insert":"\n\n"},{"insert":"You immediately go to check on Mrs. Williams, recalling her history on the way.\n\nShe is a 40 year old schoolteacher who came your office about a week ago, complaining of intermittent pain in the right upper abdomen for around two months.\n\n\u0022But this time the pain just isn\u0027t going away, doctor!\u0022, you can almost hear her voice in your head.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S15_F4.jpg"}},{"insert":"\n\n"},{"insert":"At the time of her first visit, you recall, she had tenderness in the right upper abdomen, with a positive Murphy\u0027s sign.\n"}]}
4
{"ops":[{"insert":"An ultrasound confirmed your suspicions, and once her general condition stabilized, you performed a laparoscopic cholecystectomy.\n\nThe procedure went well; you were happy to note that there were no immediate complications, and that the drain was functioning properly.\n\nThis was three days ago.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S15_F6.jpg"}},{"insert":"\n\n"},{"insert":"You reach Mrs. Williams\u0027 room and begin examining her, noting that she is still running a fever.\n\nA quick examination reveals abdominal tenderness, rigidity and guarding. Her vitals remain stable.\n"}]}
6
{"ops":[{"insert":"What do you do now?\n"}]}
1. Request an ultrasound scan
2. Order an MRCP
3. Perform an immediate exploratory laparotomy
8
{"ops":{"insert":"\n"}}
12
{"ops":{"insert":"\n"}}
10
{"ops":{"insert":"\n"}}
7
{"ops":{"insert":"\n"}}
9
{"ops":{"insert":"\n"}}
11
{"ops":{"insert":"\n"}}
