werner@aecom.UUCP (Craig Werner) (12/23/85)
To refresh, the symptoms as related by phone: > For the last week or two, the woman (age 45-50 or so) felt bloated > after meals - it was much worse after eating fried foods (so she had to give > up cooking in a wok). Not only that, but in the last week, about an hour > after eating, she developed sharp colicky pains in her right shoulder, and > felt sick and nauseous. First the point of medicine: due to a quirk of developmental biology, the nerves of the diaghram arise from the same point in the spinal cord as the nerves to the shoulder, and hence imflammation of the diaghram is "referred" to the shoulder, i.e. the brain can't tell the inputs to the 3rd and 4th Cervical Nerves apart, and assigns the pain to the most likely candidate, in this case the shoulder. (Remember in the appendicitis case, the pain was referred to the midline and expressed as being near the naval) Hence, the obvious question is, is there also pain on the right side below the diaghram. The answer was, of course, "Yes." Now, there is only one thing below the diaghram on the right side that 1) is involved in the digestion of fat [ the bloating post-fried foods ], and 2) contracts to produce cholicky, that is rapid, intermittent, sharp, pain. As I said, the obvious (:-?) diagnosis is the correct one -- the woman was having Gall Bladder attacks, or, in medicalese, Cholecystitis. Her doctor's appointment the next day confirmed the "diagnosis" by Ultrasound, and she was operated on and divested of her stone-filled and heavily inflamed gall bladder within a week or two. Epilogue: The patient has had no trouble since, but half just-to-be-sure and half out of appreciation, presented me with her newly bought Wok soon afterwards, which remains in my possesion to this day. For those who didn't get it -- don't feel so bad. Most gall bladder attacks hurt on the side where you'd expect them too, this is the more unusual presentation. And as further solace, a few of my classmates who I gave this puzzle to got so hung up on the diaghrammatic pain referral that they blocked on the next step as to what was causing it. However, it WAS Exam week, so they weren't at their best on topics not necessarily at hand. -- Craig Werner !philabs!aecom!werner "The proper delivery of medical care is to do as much Nothing as possible"