Intestinal Perforation Scenario 4.2 Intestinal Perforation

Chest X-ray

Abdominal X-ray

FAST

Abdominal CT Slice

CT Abdomen Radiology Read STUDY: Abdomen/Pelvis CT FINDINGS: CT obtained with oral contrast. Shows free air throughout the abdomen. No other obvious abnormalities. IMPRESSION: Peritoneal free air – suspected intestinal perforation.

CBC WBC 19.6 10 000-30 000/mm3 HGB 13.2 11-15 g/dL HCT 44 40-50% PLT 176 150 000-450 000/mm3

BMP Glucose 115 65-100 mg/dL BUN 16 5-20 mg/dL Sodium 137 136-145 meq/L Potassium 3.8 3.5-5.5 meq/L Chloride 99 100-106 meq/L CO2 33 22-32 meq/L Creatinine 0.9 0.2-1.4 mg/dL

Hepatic Function Panel AST 17 19-48 U/L ALT 32 17-60 U/L Alk. phos. 53 56-119 U/L T. Bili 1.0 0.4-1.5 mg/dL Albumin 3.8 3.2-4.6 g/dL GGT 45 12-58 U/L

Lactate Lactate 3.4 0.5-2.2 mmol/L

Lipase Lipase 25 21-53 U/L

Urine Pregnancy Test Negative

Urine microscopy Urine RBC None seen NS/HPF Urine WBC Urine epithelial cells Urine bacteria /HPF Urine casts NS/LPF

Urinalysis Clarity clear Color yellow Glucose negative negative mg/dL Bilirubin Ketones Sp. grav. 1.020 1.003-1.040 Blood pH 5.0 5.0-8.0 Protein Urobilinogen 0.1 0.2 EU/dl Nitrites Leukocytes Urinanalysis