This case is based on a real patient I saw last Tuesday (but I did change details).
I was in the Emergency Department and my preceptor asked me to see a patient in room 17. When I opened the door, I noticed a gaunt-appearing man probably in his forties who began to immediately scream in pain. He was bawling, cursing, howling. I managed to elicit his chief complaint, "It hurts so much," and upon further investigation, I found that he had acute onset steady epigastric pain that began yesterday (he said he stopped drinking several days ago). It was band-like and radiated to the back. He had nausea and vomiting and was restless and agitated. Past medical history was significant for infective endocarditis, osteomyelitis, hepatitis B, and hepatitis C. A police officer recognized him and said he had a record for shoplifting and burglary.
He had tenderness and guarding of the epigastrum. There was no ecchymotic discoloration of the flanks or periumbilical region. But, this was interesting:
What do you think?
1. If there were ecchymotic discoloration of the flanks or periumbilical region, this would represent two signs, which may be useful for the Boards or wards. What are they?
2. What labs would you like to order?
Image shown under fair use.