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Upper Abdominal Pain, No Relief from Pepto-Bismol: Seen in the ED
A man in his mid-sixties reports constant bilateral chest pain that radiates to the back that began yesterday. Can you Dx based on the CT image here?
Brady Pregerson, MD
History of present illness. A man in his mid-sixties with a history of endoscopy-confirmed gastroesophageal reflux disease (GERD) and esophagitis presents to the emergency department with epigastric/chest pain. He reports constant bilateral chest pain radiating to the back since the day before. He denies any aggravating factors, shortness of breath, nausea, or vomiting. He took Pepto-Bismol with minimal relief.
Vital signs & physical examination. Vital signs are normal except for elevated blood pressure (190/115 mm Hg). Other than mild epigastric tenderness, the physical examination is otherwise unremarkable.
Initial diagnostic testing
CBC: normal
CRP: 2.4
Blood chemistry: bilirubin 1.3/0.4 mg/dL, ALT/AST 120/60 U/L
Imaging: see CT below
What is the most likely diagnosis?
Clinical Tips for Using Antibiotics and Corticosteroids in IBD
January 5th 2013The goals of therapy for patients with inflammatory bowel disorder include inducing and maintaining a steroid-free remission, preventing and treating the complications of the disease, minimizing treatment toxicity, achieving mucosal healing, and enhancing quality of life.
