CASE ONE: Epigastric pain after colonscopy Colonoscopy complications -Perforation - instrument vs air pressure -Hemorrhage -Visceral injury (spleen, diaphragm, volvulus) -Infection (bacteremia, retroperitoneal abscess, appendicitis) -Pneumatic injuries (Distention, pneumoperitoneum, pneumothorax) -Rate of perforation 1/1500... increases with biopsy/polypectomy Splenic laceration/rupture from colonscopy -Incidence 0.00005-0.017%. Likely under-reported. 14 Million colonscopies per yr in US -Mortality 5%. Danger lies in delayed diagnosis. Symptoms often attributed to air insufflation or serositis. -Female predominance, increased risk prev abdominal surgeries -Mechanism? Traction on splenocolic ligament, adhesions, direct trauma -Presentation: Abdominal pain, dizziness, Kehr's sign, worsening anemia (Kehr sign referred pain from diaphragm to shoulder) -Dx; Ultrasound, DPL, CT -Management: Symptomatic, serial Hb and abd exam, possible surgery CASE TWO: Sore throat Uvular Edema: Rarely reported in isolation Etiologies: Allergy/anaphylaxis, infection, angioedema, trauma Quincke's Disease: Inhalation injury, hereditary angioedema, cocaine/marijuana abuse, idiopathic/snoring in obesity. Presentation: Dysphagia, odynophagia, sore throat, foreign body sensation. Uncommonly resp distress, dyspnea, fever. -Some association with epiglottis -If infection suspect, cover strep species and consider lateral neck xray -If not infectious, steroids +/- H2 blockers -75% recurrence rate - either first 48 hours or remote CASE THREE: Groin pain Avascular necrosis of femur -Risk factors. Trauma, steroid use, hemoglobinopathy, dysbaric phenomena, autoimmune disease, storage disease, smoking, HLD, excess alcohol consumption -Often present with groin pain, throbbing, deep. Bilateral disease 50-80% -Can by identified by painful forced internal rotation at hip -Radiographic findings: Crescent sign (intact bone with deeper area of necrosis). On MRI "single density line" early, "double line sign" found in 80% cases, high intensity line surrounded by low intensity -Treatment: 85% collapse rate, surgical intervention is mainstay. Of those treated with conservative therapy, 76% proceeded to arthroplasty
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