Frank Abdomen Case Study

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

In general he is a not acutely ill appearing male. His neck veins were elevated to the angle of the jaw. He had no thyromegaly or lymphadenopathy. His lungs were clear to auscultation. His heart was regular rate and rhythm with an S3 and an S4. His PMI was laterally displaced by 1 cm. His abdomen was (full), slightly distended and had a positive fluid wave. He had no pitting edema in the abdominal exterior wall. His rectal exam was heme-negative. His extremities showed 4+ pitting edema up to his knees and in his feet

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

BH was referred to a cardiologist in May, 2015 for complaints of chest pain. He denies chest pain or tightness at present.

History of cardiomyopathy. The most recent echocardiogram was done in 2014 showing improved ejection fraction at 55%. He feels asymptomatic, at this time. He did have recent testing with Dr. Dourdoufis. I will request those notes and review them when they arrive. He will certainly let myself or Dr. Dourdoufis know or seek care if necessary if his symptoms change acutely.

Chest and abdominal wounds were nearly always fatal. Treatment of abdominal wounds often involved pushing in protruding organs and suturing the wound. Food was withheld because fecal material leaking from the intestines caused contamination. Opium was often administered to halt the action of the digestive system. Chest wounds were cleaned and the wound was sutured. Abdominal wounds were fatal in almost 90 percent of the cases reported by Union surgeons.

Jim presented to Camberra Hospital almost one months ago with symptoms of right-sided anterolateral chest pain lasting a couple of days, a dry cough and breathlessness.

The right side of heart will increase in size as the muscle builds up and the heart rate will increase due to compensation for the left ventricle. With auscultation, the lungs will sound crackly from the liquid in the alveoli and interstitial space and when assessing respiration rate it is likely to be above thirty breaths per minute (Lewis et al., 2014). The patient may report that they are experiencing dyspnea, nocturia, fatigue, and a productive coughing. They may appear anxious and their skin may look pale (Lewis et al., 2014).

The patient may experience dyspnea, caused by pulmonary congestion. They may report orthopnea as blood is redistributed from the legs to the central circulation when the patient lies down a night, paroxysmal nocturnal dyspnea due to reabsorption of interstitial fluid when lying down, and reduced sympathetic stimulation while sleeping. Pulmonary congestion may also cause a non-productive cough. Later clinical manifestations of left sided heart failure include crackles due to pulmonary congestion and hemoptysis resulting from bleeding veins in the bronchial system caused by venous distention. On physical exam the patient may have cool, pale skin resulting from peripheral vasoconstriction, and may be restless and confused due to reduced cardiac

On Tuesday August 30, 2016 a Male 63 years of age came into Christus Spohn South Heath Center with a diagnostic order for chest and rib x-rays. He was being seen because of chest pain on his right side due to a fall. He had an extensive patient history of x-rays that went as far back as 2014. For the year of 2016 he received approximately 12 different x-ray series. For example, on January 12, 2016 he received a chest 1 view image and cardiac catheterization. On May 21, 2016 he received a chest 1 view and a complete 4 view foot. On May 30, 2016 he received a cardiac catheterization. On June 1, 2016 and again on June 2, 2016 he received a chest 1 view. On June 10, 2016 he received a catheterization. On August 25, 2016 he received a chest 2 view. On August 26, 2006 an upper extremity without contrast. The patient also has a history of open heart surgery and receives dialysis treatments and is on oxygen.

The patient has been diagnosed with atrial defibrillation and congestive heart failure. There is no visible jugular vein distention or pulsations on either side of the neck. The patient was not comfortable with removing her sweater, therefore, pulsations, lifts, or heaves were not seen if present. Palpated and auscultated the carotid arteries for vascular sounds, no bruits heard. Heart sounds were auscultated with the bell and diaphragm of the stethoscope. S1 82/min, even and regular. S2 85/min, even and regular. S3 82/min, even and regular. S4 83/even and regular. No murmurs were heard. The apical pulse rate was 92 bmp, regular and was accessed with patient in sitting position and between the 4th and 5th intercostal space. Patient stated

He underwent multiple cardiac related procedures, including a cardiac catheterization and stent placement. After discharge, he developed a fast heart rhythm (180-190 beats per minute -ventricular tachycardia) and other serious heart problems (cardiomegaly, valve regurgitation, and others) that required a cardiac defibrillator implant. He fatigued easily; his condition deteriorated and was hospitalized once more. The diagnoses listed included myocardial infarction (heart attack), acute on chronic respiratory failure, congestive heart failure (CHF), kidney failure, liver failure, hypertension, and anemia. His blood tests were abnormal.

When his pancreas gets blocked with mucus, the enzymes that are needed for digestion doesn’t reach his stomach which makes digestion problem. Frank has to take around 40-50 tablets a day to help his digestive system and to also keep his respirator symptoms in check. In addition to taking the pills most people with cystic fibrosis require about 20-50% or more calories each day than people without cystic fibrosis, so much so that they are encouraged to eat foods that are labelled ‘unhealthy’ such as chocolate and cake as it is vital to keep a healthy weight as it helps their body to deal with their chest infections effectively.

Crackles are noted in the lungs throughout. Heart is regular rate and rhythm with a rate in the 90s. Patient is on telemetry. Bowel sounds are active x4. Denies abdominal tenderness. Skin is dry and intact.

Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.