DC comes to the emergency room complaining of acute abdominal pain. She states the pain came after dinner at an all-you-can-eat buffet and has been increasing steadily. The pain is located in her right upper quadrant and is “boring” into her back. She says she feels “gassy” and bloated.
What are your differential diagnoses? Include the pathological process involved with your diagnosis. What tests would you order to confirm your diagnosis?
What treatments or interventions would be the first line of protocol for your diagnosis?
Expert Solution Preview
Introduction: In this case scenario, we are presented with a patient complaining of acute abdominal pain. As medical professionals, it is our responsibility to determine the potential causes of the patient’s symptoms and recommend appropriate tests and treatment options.
1. What are your differential diagnoses? Include the pathological process involved with your diagnosis. What tests would you order to confirm your diagnosis?
Possible differential diagnoses for the patient’s symptoms include:
– Cholecystitis: This is an inflammation of the gallbladder usually caused by gallstones blocking the cystic duct. The pain is typically in the right upper quadrant and can radiate to the back, and patients may experience nausea and vomiting. Tests to confirm this diagnosis would include an abdominal ultrasound or CT scan.
– Pancreatitis: This is an inflammation of the pancreas, which can be caused by many factors including gallstones, excessive alcohol consumption, or high triglyceride levels. The pain is typically in the upper abdomen and can radiate to the back, and patients may experience nausea and vomiting. Tests to confirm this diagnosis would include serum lipase and amylase levels.
– Peptic ulcer disease: This is a sore in the lining of the stomach or duodenum, usually caused by H. pylori infection or long-term NSAID use. The pain is typically in the upper abdomen, but can radiate to the back, and patients may experience bloating and belching. Tests to confirm this diagnosis would include an upper endoscopy.
2. What treatments or interventions would be the first line of protocol for your diagnosis?
If the diagnosis is cholecystitis, treatment options may include pain management, antibiotics to treat any infection present, and surgery to remove the gallbladder. If the diagnosis is pancreatitis, treatment options may include pain management, IV fluids to maintain hydration, and management of any underlying causes. If the diagnosis is peptic ulcer disease, treatment options may include acid-reducing medications, antibiotics (if the ulcer is caused by H. pylori), and avoidance of any contributing factors (such as NSAIDs). It is important to note that treatment will vary depending on the severity of the condition and the individual needs of the patient.
