山东大学：《诊断学》课程教学资源（PPT课件讲稿）Not Simply an Ulcer

Not Simply an Ulcer

Not Simply an Ulcer

A 67-year-old woman experienced a sudden onset of right lower abdominal pain without other associated symptoms

• A 67-year-old woman experienced a sudden onset of right lower abdominal pain without other associated symptoms

She contacted her physician who did not identify a clear etiology and referred her to a surgeon

• She contacted her physician who did not identify a clear etiology and referred her to a surgeon

The physical examination,laboratory tests and a CT scan did not demonstrate obvious abnormalities

• The physical examination, laboratory tests and a CT scan did not demonstrate obvious abnormalities

The patient underwent a laparoscopy with incidental appendectomy.Her abdominal pain subsided and she returned to work

• The patient underwent a laparoscopy with incidental appendectomy. Her abdominal pain subsided and she returned to work

One week later,she developed bilateral leg pain. She described the pain as "pins and needles" that often started when she was sitting or lying down and occasionally improved when she walked slowly.She underwent a non-invasive work up of her peripheral vasculature demonstrated slightly decreased flow through the left iliac artery. She received symptomatic therapy with naproxen and propoxyphene

One week later, she developed bilateral leg pain. She described the pain as "pins and needles" that often started when she was sitting or lying down and occasionally improved when she walked slowly. She underwent a non-invasive work up of her peripheral vasculature demonstrated slightly decreased flow through the left iliac artery. She received symptomatic therapy with naproxen and propoxyphene

One month later,she developed intense mid- abdominal pain,nausea and low-grade fever. She again contacted her local physician who admitted her because of partial small bowel obstruction with the diagnosis of diverticulitis. She improved gradually with conservative management and was discharged. Soon after discharge,she developed bilateral leg swelling and persistent fatigue. After additional two weeks,she presented for further evaluation

One month later, she developed intense mid￾abdominal pain, nausea and low-grade fever. She again contacted her local physician who admitted her because of partial small bowel obstruction with the diagnosis of diverticulitis. She improved gradually with conservative management and was discharged. Soon after discharge, she developed bilateral leg swelling and persistent fatigue. After additional two weeks, she presented for further evaluation

prior medical history Her prior medical history was remarkable for recurrent bronchopulmonary problems that had been attributed to her long smoking history

prior medical history Her prior medical history was remarkable for recurrent bronchopulmonary problems that had been attributed to her long smoking history

physical examination On physical examination she was thin,but not emaciated. There was no peripheral lymphadenopathy. Bilateral wheezing became prominent during forced expiration. The abdominal exam revealed slight tenderness without guarding or rebound. There was a large mass in the mid-abdomen and right flank,measuring about 10 cm. Normal bowel sounds were present.She had bilateral pitting edema up to the knees

physical examination • On physical examination she was thin, but not emaciated. • There was no peripheral lymphadenopathy. • Bilateral wheezing became prominent during forced expiration. • The abdominal exam revealed slight tenderness without guarding or rebound. • There was a large mass in the mid-abdomen and right flank, measuring about 10 cm. • Normal bowel sounds were present. She had bilateral pitting edema up to the knees

The pedal pulses were palpable and strong 。Active mobility,. reflexes and epicritic sensory testing were normal

• The pedal pulses were palpable and strong. • Active mobility, • reflexes and epicritic sensory testing were normal