Sthanu Profile picture
Dec 30, 2022 7 tweets 2 min read
Severe abdominal pain and vomiting

Diagnosis? Image
Small bowel obstruction

Features of small bowel obstruction include the central position of gas-filled and distended loops of bowel.

The white lines passing across the full width of the bowel are 'valvulae conniventes' - these are only found in the small bowel. Image
Small bowel obstruction (SBO) accounts for 80% of all mechanical intestinal obstruction, the remaining 20% results from a large bowel obstruction.

It has a mortality rate of ~5%. Image
The valvulae conniventes, also known as Kerckring folds/valves, plicae circulares or just small bowel folds, are the mucosal folds of the small intestine
starting from the second part of the duodenum, they are large and thick at the jejunum and considerably decrease in size distally in the ileum to disappear entirely in the distal ileal bowel loops.
They result in a classical appearance on abdominal radiographs, barium studies and CT scans. Image

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More from @Sthanu5

Dec 31, 2022
What is the diagnosis in this 52-year-old man with epigastric pain? Image
CT of the abdomen revealed dilated small-bowel loops and a "target sign," findings characteristic of intussusception, without evidence of a lead point.
Jejunojejunal intussusception caused by an adenocarcinoma was confirmed at laparotomy
Read 7 tweets
Dec 31, 2022
All these antihypertensive drugs are safe in pregnancy, except which?

Labetalol
Ramipril
Nifedipine
Methyldopa Image
Ramipril is an ACE inhibitor –

👉 ACE inhibitors are teratogenic drugs which can cause damage to the developing fetus.

Antihypertensive drugs safe in pregnancy include nifedipine, methyldopa, labetalol, and hydralazine. Image
It is well accepted that angiotensin-converting enzyme (ACE) inhibitors are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage.

First-trimester use, however, has not been linked to adverse fetal outcomes. Image
Read 6 tweets
Dec 31, 2022
What is the most likely diagnosis in this patient who had suffered a blunt head trauma 2 months earlier? Image
A 26-year-old man

👉with a history of blunt trauma to the head 2 months earlier

👉presented with rapidly progressive swelling, pain, and diminishing vision in the left eye.
👉left eye revealed chemosis, pulsating proptosis, and an ulcerated cornea (Panel A)

👉 bruit could be heard with a stethoscope placed on the left temple.
Read 8 tweets
Dec 30, 2022
Case: 23 years old female is admitted to ICU with anxiety, depression, and suicidal ideation.

Family reported recent symptoms of tic.

What is this?
Answer:

Psychology service was consulted, and they diagnosed patient with "TikTok tics."

Interestingly, there was an increase in reporting of functional tics during COVID-Pandemic.

The probable cause is mental health issues while in isolation.
A particular form is called "TikTok tics."

Most young females between the ages of 15 and 25 have been reported to have acute, complex vocal and motor tics involving large-amplitude arm movements.
Read 6 tweets
Dec 30, 2022
A 34-year-old man was admitted to the hospital with diabetic ketoacidosis.

He reported having had blurry vision, increasing shoe size, and a change in his facial features over the past several years.

Diagnosis?
On exam, he was found to have bitemporal hemianopsia.
Laboratory studies

👉 elevated levels of insulin-like growth factor 1 and growth hormone

👉 confirming a diagnosis of acromegaly
Read 6 tweets
Dec 29, 2022
Diagnosis?
Acute infarct - Dense MCA sign

The left middle cerebral artery (MCA) is very dense due to a thrombus - compare with the density of the normal right MCA
A dense artery sign may be seen before any change in the infarcted grey and white matter

Low density is already visible in the infarcted area
Read 6 tweets

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