A 30-year-old male presents with sudden abdominal pain accompanied by nausea and vomiting. His past medical history includes ESRD, HTN, Crohn’s disease, ITP, and a history of splenectomy. He is on dialysis and multiple medications.
Causes of fever : neutropenia , infection , ischemia
Vitals and Examination Temp : 38.1 C , BP : 190/128 , HR:101 , O2 saturation : 96% Abdomen : Diffuse periumbilical tenderness , soft abdomen,bowel sounds positive
Hb:7.7 , platelet : 51k ,WBC : 15k(predominant neutrophils) , Chem 7:nl, lactate:nl , LFT:nl ,BNP: 3k , Trop:506
His saturation dropped to 84% on room air. Physical examination revealed crackles in the lungs. He was on 40 L of oxygen via high-flow nasal cannula with 50% FiO2. EKG: ST elevation in V1-V6.
The patient's abdominal pain and systemic symptoms could be secondary to: Aspiration pneumonitis: Esophageal pathology causing reflux or aspiration. 1. Ascites: Compression of the diaphragm leading to shortness of breath (SOB). 2. Intra-abdominal vascular compromise: Could have triggered severe hypertension (HTN), resulting in acute heart strain and flash pulmonary edema 3.
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