1. PBL Case Discussion
——acute abdomen
刘佳滟
朱晓一

2. Paragraph 1
T1-P1
A 35-year-old man was admitted to the emergency room of hospital, complaining of abdominal pain and vomiting of 36 hours duration. The pain, limited in up abdomen and periumbilical(脐周的) at first, had become diffuse and unremitting, more marked at the right lower quadrant (RIQ右下腹 ). He had a regular bowel movement two days previously, but had been constipated(便秘 ) since the onset of abdominal pain. He had no history for other illness except having a left renal stone seven years ago, which had disappeared spontaneously.
Q1: What are the causes of abdominal pain?
Q2: Why do people vomit? How is vomiting produced?

3. Q1: What are the causes of abdominal pain?
Acute inflammation of abdominal organs
Blocking or expansion of hollow organs
Organic turn or broken
Peritoneal(腹膜的) inflammation
Vascular obstruction [1]

4. Q2: Why do people vomit? How is vomiting produced?
Symptom of upper gastrointestinal tract diseases
Nausea and vomiturition
Vomiting [1]

5. Paragraph 2
T1-P2
Laboratory investigations: WBC 12000/mm3↑, the differential count were: metamyelocyte 240(0.02) ↑, staff neutrophil 1800(0.15) ↑, segmented neutrophil 7200(0.6) ↓, lymphocyte 1800(0.15) ↓, monocyte 480(0.04), eosinophil 360(0.03), basophil 120(0.01).
Q3. What did the laboratory investigations suggest?

6. Q3. What did the laboratory investigations suggest?
Neutrophil increase
Non-segmented neutrophil accounting for over 5% [2]

7. Paragraph 3 EKG, chest X-ray, and urinalysis: normal.
T1-P3
EKG, chest X-ray, and urinalysis: normal.
Physical examination: temperature 38.5℃, pulse rate 112/ min, respiration 22/ min and BP 130/ 80 mmHg. He was somewhat dehydrated, somewhat reluctant to move in bed. The abdomen is generally soft. There was generalized abdominal tenderness, especially marked in the RIQ, and there was rebound pain there.
Q4. What is ’rebound pain’?
Q5. What’s the possible diagnosis?

8. Q4. What is ’rebound pain’?
Pain upon removal of pressure
One of the major characteristics of peritonitis [3]

9. Q5. What’s the possible diagnosis?
The symptoms of appendicitis
Suppurative infection which will lead to peritonitis

10. References [1].欧阳钦, 临床诊断学.第 1 版. 2005, 北京: 人民卫生出版社.
[2].王鸿利, 实验诊断学.第 2 版. 2005, 北京: 人民卫生出版社.
[3].陈文斌与潘祥林, 诊断学.第 7 版. 2008, 北京: 人民卫生出版社.

11. Thank You!