Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with sudden onset of severe, persistent epigastric pain radiating to the back, associated with intractable nausea and bilious emesis. Reports recent history of [alcohol intake/biliary colic]. Review of systems positive for fever, chills, and lightheadedness. Patient appears diaphoretic and in acute distress.
Clinical Examination Findings
Vitals: Tachycardic, hypotensive, tachypneic. Abdomen: Distended, hypoactive bowel sounds, marked epigastric tenderness with guarding and rebound. Skin: Presence of Grey Turnerโs sign (flank ecchymosis) and Cullenโs sign (periumbilical ecchymosis) noted, suggestive of retroperitoneal hemorrhage. Extremities: Cool, clammy, delayed capillary refill.
Treatment Protocol
Immediate admission to ICU. Aggressive fluid resuscitation with isotonic crystalloids. NPO status. Nasogastric decompression if ileus present. Analgesia via IV opioids. Broad-spectrum antibiotics if infection suspected. Serial monitoring of Hct, BUN, creatinine, and calcium. Surgical consultation for potential necrosectomy or hemorrhage control.