Case Study for Abdominal Obstruction

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 three days of abdominal pain. It initially started three 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

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.

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

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

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

A friend of mine went to the emergency department because she had severe pain in her right lower abdomen. She received a laparoscope and was notified that she required surgery immediately to get her appendix removed. While the on-call anesthesiologist was caring for a mother in labour leaving her and other patients waiting for care. She waited several hours to get access to an anesthesiologist to receive medical care before her surgical procedure. After her surgery, the surgeon stated her appendix was really severe, and they were lucky enough to perform surgery before it ruptured. If she had waited longer her appendix could’ve ruptured, and it would’ve been very dangerous and life-threatening. Based on this experience I will examine how

Edna, T., Talabani, A. J., Lydersen, S., & Endreseth, B. H. (2014). Survival after acute colon diverticulitis treated in hospital. International Journal of Colorectal Disease,29(11), 1361-1367. doi:10.1007/s00384-014-1946-3

Also, I see that the SAE (Acute Upper Gastrointestinal Hemorrhage) that caused this hospitalization on was reported on 13Apr2017, but the event occurred 05Mar2017 to 14Mar2017 were you aware of this hospitalization prior to the patients week 24 visit on 12Apr2017, as SAEs need to be

Shouldice Hospital is one where only external abdominal hernias are operated. The hospital has a unique “technique” for this which was developed by Dr.Earle Shouldice, the founder of the hospital. The hospital with its low cost solution, properly routine tasks, facilities for the patients and their visitors, high quality service, and best in industry doctors and staff had a competitive edge. The Shouldice Hospital in itself is not just a curing centre but a holistic experience for its patients, doctors, nurses and supporting staff alike.

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.

Other causes can be associated with pain from the partial bowel obstruction. Overstimulation could of happen from being in the hospital and having new things happen around him. Social isolation is another reason because he stuck in a room and can’t wander would causes agitating. Disruption of usual routines, the hospital routines are nothing like his nursing home routine causing confusing and agitating. Another one of these could be unmet, physical needs related to lack of sleep, thirst, hunger (routine when they eat and drink are different in the hospital), fatigue or elimination. These may go unmet due to the nursing staff lack of knowing the patients’ needs or lack of asking the patient.

Assess: Caroline Morris is a day five post-operative ileostomy patient with a thirty year history of ulcerative colitis. Her vital signs have been stable. She has been experiencing pain which she has rated an eight out of ten however, she refuses further pain medication. She is ready for discharge.

DS is a 57-year-old white female whit a history of diverticulitis who presents to the clinic for an evaluation of abdominal pain. She stated that she began experiencing left lower quadrant pain last night that worsened through the night and into this morning. The pain is described as dull, occasionally cramping, rated 7/10 in severity. The patient also stated that this pain is similar to previous episodes of diverticulitis. The patient stated that she took Gas-X this morning with little relief. She was able to move her bowels yesterday and this morning, both reportedly normal. The patient denied any fever, chills, chest pain, shortness of breath, nausea, vomiting, diarrhea, melena, hematochezia, or any other symptoms. At this time, there were