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Showing content with the highest reputation on 05/08/2013 in all areas

  1. Sounds most like a leaking AAA. With his liver failure he is at high risk of bleeding so even a small leak can be catastrophic. Only about 50% of cases of ruptured AAA present with the classic triad of severe acute pain, pulsatile mass and hypotension. He is most likely bleeding into his abdomen from somewhere or other possible diagnoses are a perforated bowel or even severe acute pancreatitis. The mass in his RUQ is most likely his enlarged liver. The medication he was on was probably lactulose which scavenges the ammonia from the blood and into the colon in liver failure patients. It is more commonly used for constipation which is why he has chronic diarrhea. Monitor, 2 large bore IV's, NRB with O2, titrate small fluid boluses to maintain normal GCS. Don't pour the fluids in wide open unless he has altered mental status and severe hypotension just in case it is a ruptured AAA. Treat the pain once you have adequate BP. Rapid transport to nearest surgical facility.
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