tag:blogger.com,1999:blog-4082643038671225434.post4859458547824452521..comments2023-10-07T01:34:01.774-07:00Comments on Case of the Day: Double EntendreCraighttp://www.blogger.com/profile/17072102331564743101noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-4082643038671225434.post-89776656505656460492008-02-06T07:50:00.000-08:002008-02-06T07:50:00.000-08:00Double EntendreThis seems like the textbook presen...Double Entendre<BR/><BR/>This seems like the textbook presentation of acute pancreatitis, most commonly due to alcoholism in men and gallstones in women. Ecchymotic discoloration of the flanks would be Grey-Turner’s sign and that of the periumbilical region would be Cullen’s sign; both represent retroperitoneal bleeding due to pancreatic necrosis (or other etiologies). Lab tests to order include serum amylase and lipase though these tests are not specific or diagnostic. Imaging studies should also be done.<BR/><BR/>However, it turns out this guy did not have pancreatitis. The image showing track marks on the arm and the history suggesting IV drug use (PMHx and police record) make you think twice about the diagnosis. It turned out when I saw this patient, he was suffering from opiate withdrawal and was drug-seeking. This could be considered malingering or fabricating symptoms for secondary gain.<BR/><BR/>Source: UpToDate; heroinabuse.netCraighttps://www.blogger.com/profile/17072102331564743101noreply@blogger.comtag:blogger.com,1999:blog-4082643038671225434.post-10776647416910085852008-02-04T22:42:00.000-08:002008-02-04T22:42:00.000-08:00Pancreatitis. Cullen's sign and Grey-Turner's sig...Pancreatitis. Cullen's sign and Grey-Turner's sign. Order lipase and amylase.Alexhttps://www.blogger.com/profile/06972701448751949861noreply@blogger.com