NBME Step 2 CK Form 8 CT scan of the abdomen (NBME Answers)

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submitted by ∗step_prep2(66)

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Adolescent in a traumatic accident who presents with severe epigastric tenderness, nausea, vomiting, hypotension and tachycardia, normal abdominal ultrasound and normal LFTs, most consistent with duodenal hematoma > traumatic pancreatitis; in either case, the best next step would be CT scan of the abdomen
Key idea: CT scan is better than ultrasound in setting of pancreatitis, especially when etiology is not gallstones
Key idea: Morphine and other opioids (except meperidine) can lead to sphincter of Oddi dysfunction, which can further increase risk for pancreatitis

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jj375 Couldnt this just be a Duodenal Hematoma that causes pain? and not necessarily pancreatitis? When you eat and food hits duodenum, you stimulate peristalsis which I assume would be painful with a duodenal hematoma. You would still do a CT to visualize the hematoma and confirm +2

cbreland My thought process: he had blunt trauma, let's get a CT +1