Male, 30 years old, who was admitted to the emergency room with abdominal pain for 4 hours The patient felt upper abdominal discomfort after drinking and overeating 5 hours ago, and felt sudden acute pain under xiphoid process 4 hours ago, accompanied by nausea and vomiting of stomach contents for several times, abdominal pain spread to the right middle and lower abdomen 3 hours ago. The patient refused to press the abdomen because of pain, fidgeting, cold sweat. PE: flat abdomen, extensive muscle tension, obvious tenderness under xiphoid process, right middle and lower abdomen, most prominent under xiphoid process, bowel sounds occasionally heard. For further diagnosis and treatment, she was admitted to the emergency department. Intermittent epigastric pain for 8 years, apparent hunger, without systematic diagnosis and treatment. PE: T37.6℃, P104 times/min, R24 times/min, BP90/60mmhg. Acute painful appearance, irritability, no obvious changes in cardiopulmonary examination, flat abdomen, no gastrointestinal type or perioperative wave, extensive abdominal tension, tenderness in the inferior xiphoid process and the right middle and lower abdomen, obvious rebound pain, most prominent in the inferior xiphoid process, liver and spleen not reached, Murphy sign (-), and mobile dullness (-). Bowel sounds were occasionally heard, and rectal digital examination was not abnormal. Auxiliary examination: WBC 11×109/L, Hb 140g/L; Blood amylase 96U (control 32U) Please briefly describe the diagnosis and basis of diagnosis, differential diagnosis, further examination, and treatment principles.
Male, 30 years old, who was admitted to the emergency room with abdominal pain for 4 hours
The patient felt upper abdominal discomfort after drinking and overeating 5 hours ago, and felt sudden acute pain under xiphoid process 4 hours ago, accompanied by nausea and vomiting of stomach contents for several times, abdominal pain spread to the right middle and lower abdomen 3 hours ago. The patient refused to press the abdomen because of pain, fidgeting, cold sweat. PE: flat abdomen, extensive muscle tension, obvious tenderness under xiphoid process, right middle and lower abdomen, most prominent under xiphoid process, bowel sounds occasionally heard. For further diagnosis and treatment, she was admitted to the emergency department.
Intermittent epigastric pain for 8 years, apparent hunger, without systematic diagnosis and treatment.
PE: T37.6℃, P104 times/min, R24 times/min, BP90/60mmhg. Acute painful appearance, irritability, no obvious changes in cardiopulmonary examination, flat abdomen, no gastrointestinal type or perioperative wave, extensive abdominal tension, tenderness in the inferior xiphoid process and the right middle and lower abdomen, obvious rebound pain, most prominent in the inferior xiphoid process, liver and spleen not reached, Murphy sign (-), and mobile dullness (-). Bowel sounds were occasionally heard, and rectal digital examination was not abnormal.
Auxiliary examination: WBC 11×109/L, Hb 140g/L; Blood amylase 96U (control 32U)
Please briefly describe the diagnosis and basis of diagnosis, differential diagnosis, further examination, and treatment principles.
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