Entangled
Gastrointestinal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S4_F1.jpg"}},{"insert":"\n\n"},{"insert":"It is a beautiful morning, and you are off-duty for once.\n\nYou decide to use this opportunity to visit your uncle, who lives in a small town just an hour\u0027s drive away.\n\nYou try to visit him whenever possible, as he lives alone, and has been on treatment for Parkinson\u0027s Disease for the last 5 years.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S4_F2.jpg"}},{"insert":"\n\n"},{"insert":"Your uncle\u0027s face, usually devoid of emotion, lights up at the sight of you, and he insists that you stay for lunch.\n\nDespite repeated reassurances, you cannot shake off the nagging feeling that your uncle is not as well as he says he is.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S4_F3.jpg"}},{"insert":"\n\n"},{"insert":"During lunch, you notice that your uncle is clutching the cutlery so hard that his knuckles are pale.\n\nHe also fidgets about as if in pain.\n\nHe abruptly pulls himself up and declares that he \u0022needs to lie down for a bit\u0022.\n\nHalfway to his room, he doubles up in agony. You rush to his side.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S4_F1.jpg"}},{"insert":"\n\n"},{"insert":"Your uncle confides that he has been experiencing episodes of abdominal pain for the last 2 days, along with absolute constipation for 3 days.\n\nYou decide to rush him to the hospital where you work.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S4_F5.jpg"}},{"insert":"\n\n"},{"insert":"Upon admission, he is extremely anxious and tachycardic with otherwise stable vitals.\n\nHis abdomen is mildly distended and diffusely tender. The digital rectal examination reveals an empty, collapsed rectum.\n"}]}
5
{"ops":[{"insert":"What is your next step?\n"}]}
1. Order an urgent contrast enhanced CT scan of the abdomen
2. Order an urgent supine abdominal radiograph
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