1. Intern Seminar
Intern 黃維立, 張修碩
2006/03/29

2. Identify data Name: 陳XX Sex: ♂ Age: 72 y/o Chart number: 0108xxxx
Admission date: 2006/03/04

3. Chief complaint
Acute onset of slurred speech on ¾ morning

4. Past history DM HTN Parkinsonism disease Paroxysmal Af
History of lacunar stroke for several episodes

5. Brief history
He has just discharged 2 weeks ago with the diagnosis of frequent TIA.
Due to slurred speech  admission with the impression of recurrent lacunar infarction
During hospital course, one episode of stroke occurred with the presentation of left hemiparesis

6. During hospital course…
Fever, hiccup, nausea, and vomiting since 3/10 evening
This patient complained of abdominal dull pain in the afternoon since 3/11.
Constipation hx  先以此方式處理

7. Physical examination Abdomen Bowel sound: normoactive
Soft but tenderness
No rebounding pain
No muscle guarding
Tenderness at McBurney point (±)
(-) psoas sign, obturator sign
Pain progression  abdominal CT ＋ ＋ ＋

8. Image study: KUB
2006/03/11

9. During hospital course…
However, vomitus with coffee-ground content occurred on 3/12.
Intermittent diffuse abdominal dull pain with progressive distention
Constipation hx  先以此方式處理

10. Physical examination 3/12
Abdomen
Bowel sound: hypoactive
Soft but tenderness
No rebounding pain
No muscle guarding ＋
Pain progression  abdominal CT ＋ ＋ ＋ ＋ ＋ ＋ ＋ ＋ ＋ ＋ ＋

11. Laboratory data 3/12 Leukocytosis: WBC=22.3K/cmm
Elevated CRP level: 254 MG/L
Abnormal liver function: GOT/GPT=893/685
 consult GI man

12. Image study: KUB
2006/03/11
2006/03/12

13. Image study: abdominal CT 3/12
Air-fluid level
acute appendicitis is unlikely

14. acute cholecystits is unlikely

18. Operation findings 3/12

19. Discussion