Epigastric Pain, Nausea, and Vomiting in a Young Man

BY KATHRYN M. DEPRIMO & KHALID MALIK, MDA 30-year-old man with no previous medical history presented with one day of epigastric pain, nausea, and vomiting. He described the pain as moderate, aching, and nonradiating. He said Tylenol provided minimal relief.The patient reported vomiting four or five times since the start of his symptoms and described the vomit as yellow in color. He had no history of recent travel, recent sick contacts, trauma, pain with eating, fever, chills, shortness of breath, chest pain, headaches, dizziness, changes in bowel movements, or urination. The patient confirmed a past surgical history for a broken left arm as a child. His father also had diabetes, and his paternal uncle had an unknown cancer.The patient said he smokes cigarettes once a month, but reported no illicit drug use. He said he drinks beer, up to eight to 10, and confirmed drinking 10 beers two days before he presented to the ED. Review of systems confirmed abdominal pain, nausea, and vomiting, but all others were negative. His physical exam was unremarkable.A CT with contrast of his abdomen and pelvis showed an ill-defined region of hyperenhancement at the hepatic dome but no cholelithiasis. Extensive peripancreatic stranding with enlargement and hypoenhancement were seen in the pancreatic head. Associated wall thickening with extensive stranding surrounding the distal gastric body and duodenum was also noted. Free fluid was seen in the right upper quadrant and along the righ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research