What’s the Diagnosis #16 — Mmmmm, Eggs

This is an interesting case for a number of reasons. First, it shows how a little testing can turn into a lot of testing to “rule out” diseases in the emergency department. Second, it hopefully provides some good teaching points. Third, the comment from the attending physician gave me the giggles. That will explain the title. But you have to read through the case to understand the comment. I’m not going to discuss all the minute details of the case, only the major findings that contribute to the flow of the case. A patient got sent in from the nursing home because her gastrostomy tube was leaking blood and the nursing home was convinced that the patient was having GI bleeding. When the bandage over the patient’s G-tube was removed, it was fairly obvious that the skin about the G-tube site was the source of the blood. The skin was raw and was oozing dark red blood. Flushing the G-tube produced a little blood, but the blood cleared. The patient’s vital signs were stable except for a mildly elevated pulse. Proper skin care probably would have resolve the bleeding. Some people may have left it at that and sent the patient back to the nursing home. I drew labs and did an abdominal series. The patient was mildly anemic. Her hemoglobin was 11. There was no blood in her stool. Her BUN was mildly elevated at 24 which suggested that she was behind in her fluids but not that she was having a significant upper GI bleed. With significant GI bleeds, BUN tends...
Source: WhiteCoat's Call Room - Category: Emergency Medicine Doctors Authors: Tags: Medical Topics Patient Encounters Source Type: blogs