Answer VizD 1.3

VizD Winners:

Devon Moore          Brian McMichael

Chris Guyer            Maria Pak

Answer to Case 1.3

Name that Bodily Fluid

1. A 23-year-old man after performing 30 minutes straight of leg-squats.

2. A 66-year-old woman with abdominal pain and distension.

3. A 42-year-old man with epigastric pain that radiates to his back.

Questions for each image above:

1. What is the fluid?  What condition it is associated with?

2. What is the fluid?  What condition is it associated with?

3. What is the fluid?  What condition is it associated with?


1. Myoglobinuria. Associated with Rhabdomyolysis.  Urine color may be reddish-brown due to the presence of myoglobin.  Positive for blood on dipstick exam, but no RBCs are seen on microscopic exam.

2. Bilious emesis. Associated with obstruction distal to the Sphincter of Oddi (location where bile enters digestive tract).  The presence of bilious emesis excludes the presence of gastric obstruction. Bilious emesis in children is associated with malroation and volvulus and requres emergent intervention.

3. Melena. Black, tarry stool asscoiated with GI hemorrhage (most commonly peptic ulcer disease).  The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

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