Postgrad Med J 2001;77:535
( August )
Self assessment questions
A man with a murmur requiring nutritional
support
S D Hearinga, I S Shawb, A Dayc, C S J Proberta
a Bristol Royal
Infirmary, Bristol, UK: University Division of Medicine, b Department of
Gastroenterology, c Department of
Chemical Pathology
Correspondence to: Dr
Christopher S J Probert, University Division of Medicine, Bristol Royal
Infirmary, Bristol BS2 8HW, UK
c.s.j.probert@bristol.ac.uk
Submitted 16 August
2000;
Accepted 10 January 2001
| The first 150 words of the full text of this article appear below. |
A 52 year old man complained of
severe abdominal pain of 24 hours' duration. He had had two episodes
of bloody diarrhoea in the past six hours. Medical history was
unremarkable. On examination he was systemically unwell, pyrexial
(37.5°C), and was noted to have several splinter haemorrhages in his
fingernails. Cardiovascular examination revealed a tachycardia (120 beats/min), an irregularly irregular pulse, blood pressure 100/80 mm
Hg, and a diastolic murmur loudest at the apex. Abdominal examination
revealed generalised tenderness with guarding in the lower abdomen.
Initial investigations were as follows: haemoglobin concentration 113 g/l, white cell count 21 × 109/l, platelet count 550 × 109/l, serum sodium 134 mmol/l, potassium 3.4 mmol/l, urea
9.2 mmol/l, creatinine 102 µmol/l, arterial pH 7.22, and bicarbonate
14 mmol/l.
At laparotomy a large amount of small and large bowel was resected,
leaving 20 cm ofjejunum, and a jejuno-transverse colonic anastomosis was performed.
Three months after surgery the patient was admitted with severe
dehydration, anuria, and carpopedal spasm. . . . [Full text of this article]
