Abdominal Assessment Paper

Abdomen: Obtuse with minimal bowel sounds, slightly distended. There is RLQ (right lower quadrant) tenderness with guarding and with pinpoint rebound. Positive McBurney and obturator signs with a negative psoas sign.

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.

INTRODUCTIONThis is a case study concerning a patient presenting with low abdominal pain, frequent micturation and dysuria. I will discuss the consultation and show how I used the problem solving consultation style detailed by Alison Crumbie. This involves listening to the patients' initial complaint and developing hypothetical diagnosis. Focused questioning and clinical examination and investigations will then be used to eliminate some of the initial hypotheses. The patients' perspective of their problem will be addressed and the synthesis of gathered information will enable the practitioner to arrive at a differential diagnosis and to agree on a treatment plan with the patient so that they can manage their problem.

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination.

Patient was in the ER room when first seen. PT was with her family members and family states that she speaks little English and that she has had abdominal pain for the past day along with bloody stools. Family states that she is on calcium supplements and no other medications. Last oral intake is 24 hours ago. Family states no known past medical history. Pt is in the hospital bed in the fetal position and towards the right side. Patient's airway is clear and breathing is normal. Skin is warm and dry. Patent is AAOx4. Assessment of head, neck, and chest show no signs of deformities. Abdominal area not assessed due to severe pain. Back is without deformity. The upper extremity shows no sign of deformities or trauma. The lower extremity shows

Patients present with left lower quadrant pain, reiterating the tendency for diverticulitis to affect the sigmoid colon in western countries. The pain can be constant or intermittent, and lack of appetite, or nausea and vomiting can be present. Physical examination of the abdomen reveals localized tenderness but frank rebound or guarding should be negative. Bowel sounds are frequently distant or depressed, if bowel sounds are very active an obstruction may be present, in mild cases the bowel sounds may be normal. The WBC may be elevated and the patient may present with a fever. Occasionally a palpable mass may be felt and may be very painful. Eating exacerbated the pain of left-sided diverticulitis and pain can be lessened with the passage of feces or flatus. Patients may complain of a feeling of being bloated.

A woman is brought to an emergency room complaining of severe pain in her left iliac region. She claims previous episodes and says that the condition is worse when she is constipated, and is

0900 Pt in her room lying on her bed with watching TV. Good appetite this morning, Ate 100% of her breakfast. Alert and oriented x 4 and follow commands. Vital sign T96.9, P 72, R 18, BP 113/61, O2 Sat 97 RA. Pt complained pain on her back and rate 6/10 on scale of 0 to 10. skin warm to touch and redness on the area. Lung sound clear and even to auscultated in all lobes. Breath sound regular and even. S1 and S2 auscultated. Abdominal sound presents and actives in all four quadrants. ABD soft, non-tender, no distended to palpate. Pt denied ABD pain. Pt stated last bowel movement yesterday night, medium, soft and formed. Call light within her reach, nonskid socks on, bed in down position. Will continued to monitor……………………….L.Gotora PNS2/WATC

Sakeenah is 14 years old African american girl, she comes to the University of Michigan Pediatric Gastroenterology clinic on 5/22/2018 complaining of abdominal pain. She is accompanied mom and dad today and she provides the interval medical history, She states that the pain started month ago, epigastric, and occasionally radiate to right side, described as squeezing or burning pain. She states that the pain is on/off, in scale of 7-8/10, occur more in the morning. The pain lasts few hours several time a day. She feels that "food sits in my stomach and doesn't digest." Sakeenah states that pain is worse when she eating a grassy food, she stop eating it for a while and the pain seems

The patient states she feels as though her abdominal pain after full workup by the gastroenterologist, is likely related to muscular symptoms. She does state there are certain ways she can move, that she will get the pain.

Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects of the physical examination and had to be prompted by the MO. Although with more practice such incidence would be reduced.