Although this patient is at high risk of DKA, the urinary ketones are normal, making DKA unlikely. Diabetic ketoacidosis (DKA) also presents with abdominal pain, hyperglycemia, AGMA, and glucosuria. ………… Acetaminophen overdose and viral hepatitis also cause nausea/vomiting, RUQ pain, hyperbilirubinemia, and occasionally an AGMA however, transaminases elevations are expected to be in the thousands. Of the biliary obstruction with either endoscopic retrograde cholangiopancreatography or percutaneous drainage.
Management includes broadspectrum antibiotics, aggressive intravenous fluid resuscitation, and relief The imaging modality of choice is a RUQ abdominal ultrasound, which demonstrates common bile duct dilation or evidence of biliary obstruction (eg, choledocholithiasis). An anion gap metabolic acidosis (AGMA) commonly occurs from lactic acidosis with severe sepsis. In addition to leukocytosis with a left shift, classic laboratory findings include direct hyperbilirubinemia and elevated alkaline phosphatase (reflecting cholestasis). Common etiologies include choledocholithiasis, malignancy, primary sclerosing cholangitis, and biliary interventions that result in incomplete bile drainage. Acute cholangitis is a lifethreatening infection that typically develops in the setting of biliary obstruction, which enables bacteria to enter the ampulla and biliary tree. The classic Charcot triad of fever, right upper quadrant (RUQ) pain, and jaundice (not noted in this patient, although it may develop with worsening hyperbilirubinemia) is only seen in 50%-75% of patients Reynolds pentad (additional hypotension and altered mental status) is classically associated with severe disease. Acute hypotensive illness and leukocytosis are not typical.Ī patient's presentation is consistent with acute cholangitis. Although it has a cholestatic pattern on liver function studies, patients are frequently asymptomatic or have chronic fatigue and pruritus on presentation. PSC is characterized by short, annular strictures alternating with a normal bile duct ("beads on a string") visible on ultrasound. In addition, the hyperbilirubinemia is primarily indirect, and fever is atypical.
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This patient should have serial blood counts drawn and may require transfusion if the hemoglobin decreases to 3000 U/L).
≥2.5 g/dL (high-protein ascites) o CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd-Chiari syndrome, fungal 9 g/dL in variceal hemorrhage. ≥250/mm3: peritonitis (secondary or spontaneous bacterial)
US-MLE Step 2 CK – UW Explanations/Tables INTERNAL MEDICINE GASTROINTESTINAL & NUTRITION ASCITESīLOODY: trauma, iatrogenic (e.g., bx, paracentesis), malignancy (tumor eroding blood vesselsHCC is MCC of bloody), TB (rarely) MILKY: chylous TURBID: possible infection STRAW COLOR: likely more benign causes
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