Break

Gastrointestinal System


Step 1: View Clinicals

A 54-year-old man presents with sudden severe central chest pain for 2 hours. The pain does not radiate, and is not exacerbated or relieved by changes in posture. He also experienced nausea, vomiting, and sweating.


His medical, surgical, and family histories are unremarkable. He does not smoke and only drinks socially. A routine health evaluation a month ago showed his fasting blood glucose, lipid profile, renal functions, and liver functions to all be within normal parameters.


Step 2: Order Relevant Investigations

1. Serial ECGs

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Serial ECGs are completely normal.

2. D-dimers

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D-dimer levels are not elevated.

3. X-ray chest

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There is air in the mediastinum, but no air under the diaphragm. A small left-sided pleural effusion is present.

4. Esophagogram with water-soluble contrast

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There is extravasation of contrast from the left lower esophagus, into the left pleural cavity.

Step 3: Select Appropriate Management

1. Nil per oral

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2. IV proton pump inhibitors

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3. Surgical management

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4. Parenteral nutrition

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