Volume 11

Picture Quiz: An Acute, Blue, Swollen, Painful Leg (Answer)

Picture Quiz, Volume 11, Issue 4, Pages 193 - 264 (2012)

Case Outcome

Urgent Duplex ultrasound demonstrated ilio-femoral deep vein thrombosis (DVT) with involvement of the long saphenous and short saphenous superficial veins. Arterial Doppler waveforms were normal distally with no evidence of stenosis. The diagnosis was therefore Phlegmasia cerulea dolens (PCD), resulting from an extensive, proximal DVT with total or near total venous outflow occlusion.

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Problem-Based Review: A patient with metabolic acidosis

Trainee Section, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Metabolic acidosis is a common metabolic derangement present in the acute medical patient. A thorough and structured investigative approach is required as there are many causes and management is reliant on identifying these. In particular calculation of the anion gap with correction for albumin level and use of the delta ratio can be helpful in complex cases especially in patients where a combination of metabolic derangements may be present.

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Problem based review: the patient with dizziness on the AMU

Trainee Section, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Unsteadiness, balance disturbance, and ‘dizziness’ are common presenting complaints on the Acute Medical Unit. This article outlines key components in the evaluation of these problems and describes the most common clinical patterns of dizziness. A case history is used to highlight some key learning points.

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Sepsis- what is the role for acute medicine?

Viewpoint, Volume 11, Issue 4, Pages 193 - 264 (2012)

Introduction

Sepsis- the life-threatening response of the body to an infection- is one of the more common reasons for presentation to an Acute Medical Unit, and a major health and economic burden to our healthcare system, with an estimated 37,000 deaths occurring annually in the U.K. In the United States, recent evidence suggests that the incidence of sepsis has been rising by between 8 and 13% per annum over the last decade, and that it is now higher than that of Acute Coronary Syndrome.1 Across Europe, the cost of a hospital admission for sepsis (due to the frequent need for prolonged Critical Care admission) has been estimated at between 25,000 and 55,000 Euros.2 For the NHS, this means an estimated expenditure of £2.5 billion per year.

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Picture Quiz: An Acute, Blue, Swollen, Painful Leg

Picture Quiz, Volume 11, Issue 4, Pages 193 - 264 (2012)

Case History

A 55 year old male presented to the Acute Medical Unit with a one hour history of pain and swelling of his right leg with resultant inability to weight bear. He denied any preceding history of trauma. Previous medical history was unremarkable. He was taking no regular medications, and did not use recreational drugs. There was no prior weight change, or alteration in bowel habit, no associated chest pain or dyspnoea and there were no risk factors for venous thromboembolism or arterial thrombotic disease. He was a lifelong non-smoker.

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Exertional Syncope as a presenting feature in Guillain-Barré syndrome

Case Reports, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Guillain-Barré syndrome (GBS) is an acute demyelinating disorder of the peripheral nervous system that results in motor weakness, absent reflexes and autonomic nervous system dysfunction. Autonomic failure is reported in approximately 65 % of patientswith GBS and usually follows extensive motor involvement. In this case our patient presented with syncope and other signs of autonomic failure before the motor weakness developed. Few cases in the literature have reported features of autonomic failure before established weakness in GBS; to our knowledge, syncope has not been described previously as a presenting feature of GBS.

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Intra-abdominal abscess in older patients: two atypical presentations to the Acute Medical Unit

Case Reports, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

An abscess is a localised collection of necrotic tissue, white cells and bacteria, collectively forming pus. Intra-abdominal abscesses can occur viscerally (e.g. hepatic abscess), retroperitoneally (e.g. psoas abscess) or intraperitoneally (e.g. subphrenic abscess).1, 2 Clinical presentation is variable and largely depends on the site of abscess. Fever and abdominal pain are the classic symptoms although in older people presentation can be non-specific. Prompt diagnosis and early intervention are vital for good outcomes.3 We present two cases of older women whose presentation with atypical symptoms resulted in a delay in diagnosis.

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