b'SCIENTIFIC ASSEMBLY PACEP 2023 CPC HIGHLIGHTWhat is the Diagnosis?A special thank you to Alexandra Amaducci, DO, FACEP for organizing the CPC competition during Scientific Assembly and to Patrick McGuire, MD from UPMC Harrisburg for submitting the case and being the resident presenter, and Timlin Glaser, DO from Lehigh Valley Health Network for being the discussant.CPC CASE The Case58-year-old male STUDY HPI Musculoskeletal: neck supple,THE CASEPresents RLQ and suprapubicnormal ROMabdominal pain Skin: warm and dry, cap refill less Associated symptoms: nausea/ than 2 secondsvomiting, fevers/chills, headache,Neurological: A&Ox3, no focal deficitdark urine Psychiatric: normal mood, normalExtra-GI: hepatitis, GB disease, splenic Recent ED visit for similar, exceptbehavior infarction/rupture, pancreatitisabd pain is new Labs: Vascular: mesenteric ischemiaPain rated 8/10 intensity CBCWBC 16.0/RBC 4.92/Hgb 14.7/HctSkin: herpes zosterROS:dental work 6 months ago and44.2/Plt 58 Renal/GU: UTI +/- stone, testicular still has pain BMP/LFTNA 131, K 3.1, Cl 97, CO2 23,torsionPMH: chronic back pain, PTSD BUN 33, Cr 1.37, Glucose 169, Ca 8.4,Hematologic: SCC, FMFPSH: back surgery Gap 11.0, Protein 6.2, Albumin 3.1, TotalMisc: narcotic withdrawalMeds: none bili 7.2, Direct bili 5.0, AST 198, ALT 174,Liver:Viral hepatitismultiple, Liver Allergies: NKDA Alk Phos 204 abscess, Autoimmune hepatitis, Soc: denies tobacco/EtOH/drugs,Troponin 0.52Infiltrative disease, Sarcoidosis , works at Goodwill, Long-time sheepLactate normal Amyloidosis, Tuberculosis farmer in Morocco Lipase normal Gallbladder/Biliary: Cholecystitis, Vitals: Temp 36.7 C (98.1 F), HR 100,COVID negative Choledocholithiasis, Cholangitis, RR 18, 126/62, SpO2 96% Imaging Primary Sclerosing, Ascending, Physical: Gallbladder Abscess, HEENT: Head: normocephalic,CXR: Probable atelectatic changesCholangiocarcinomaatraumatic, Nose: normal, Mouth/ left lung base. Blunting of the leftBacterial infections:Brucellosis,Q fever,Throat: dry mucous membranes,costophrenic angle suggests smallLeptospirosis,Lyme (rarely)Eyes: scleral icterus, EOM intact,pleural effusion.Parasitic infectionsPERRLA CT head: unremarkable Liver flukes, Clonorchiasis, Cardiovascular: RRR, normalGB POCUS: no gallbladder wallOpisthorchiasis, Fascioliasis, pulses, normal heart sounds thickening or mass of the gallbladderSchistosomiasis, Leishmaniasis Pulmonary: effort normal, normalDifferential Diagnosis (visceral), Echinococcosis , Amebiasisbreath sounds GI: gastroenteritis, appendicitis, Abdominal: flat and soft, noSBO/LBO, intra-abd abscess, colitis, distention, with generalizeddiverticulitis, peritonitis, IBD, tenderness. Right CVA tenderness. malabsorptionWhat test will make the diagnosis?What is the final diagnosis?see conclusion on page 23PACEP News | Winter 2024 19'