Case 6
Thursday, May 3, 2012 at 11:23AM 46 yo M w/ h/o colon CA (last chemo 2/2012), DVT (on lovenox), HTN,
DM p/w SOB associated with sharp CP radiating across his anterior
chest x 6 housr and 3-4 days of diffuse abd pain and distension (last
BM this AM). PT found to have low-grade fever.
PE:
VS: 100.4 HR 122 RR 25 BP 112/54 O2 97 on 3L
CONSTITUTIONAL: Distress: Mild. Patient appears chronically ill.
Patient is alert.
CARDIOVASCULAR: Rate: Tachycardia.
MUSCULOSKELETAL/EXTREMITES: Non-tender, normal ROM, no pedal edema or
calf tenderness. NVT intact.
RESPIRATORY: (-) Respiratory distress. Wheezing: Absent. Rales:
Absent. Rhonchi: Absent. Diminished BS: None.
GI/ABDOMEN: Palpation: generalized abd tenderness w/ guarding, no
rebound Organomegaly/Mass: No organomegaly, or pulsatile mass. Bowel
Sounds: normal. Occult Blood: Heme negative stool. brown stool
INTEGUMENTARY: Color normal for race, warm and dry, no rash.
HEME/LYMPH: No adenopathy, no palpable or tender nodes.
EYES: PERRL, lids and conjuntivae are normal on exam.
NEURO: Oriented x3. Cranial nerves II-XII within normal limits. No
motor or sensory deficits. no neurological symptoms above or below the
diaphragm.
PSYCH: Oriented x3, mood and affect is normal.
Labs: CE: neg x 1
BNP 42
Glucose 472
BUN 20
ratio 11.9
Creat 1.68
GFR 44
Na 128
K 6.0
Cl
96
CO2 24
Alk phos 223
AST 19
ALT 22
WBC 19.61
H/H 10.6/34.9
Platelet 450
PT/INR 16.9/1.4
PTT 23.1
Lipase 13
1. What ultrasound exam is being performed and what if any findings do you see below?
2. What could be the cause of the finding seen in the gallbladder below, what is the finding?
Reader Comments (2)
posting comment
1. This is an abdominal ultrasound demonstrating views of the right upper quadrant, left upper quadrant, and pelvis. One view of the gallbladder is also demonstrated. The pathology is free abdominal fluid c/w ascites.
2. Gallbladder wall thickening is demonstrated. Ascites, hypoalbuminemia, cholecystitis, and adenomyomatosis may cause gallbladder wall thickening.