Lars Johnson Case

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.

When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam or CT Scan, the most sensitive and specific test for gallstones. Other exams that may be performed are a Cholescintigraphy a.k.a. HIDA (hepatobiliary iminodiactec acid) Scan, ERCP (endoscopic retrograde cholangiopancreatography), and blood tests.

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.

My patient is a 64-year-old that came in for upper abdominal pain. She felt her pain was worse when she lied down flat, so she had been trying to sit up and lean forward for most of the day. As the day went on her pain got worse, so she came into Emergency Department for further evaluation. She did not have any nausea or emesis and no change in her bowel habits. No fevers or chills. No trauma to the abdomen. In the hospital, she is diagnosed with acute pancreatitis.

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

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.

It’s always good to start investing money at an early age, however, it’s a hard start. Many banks have improved interest rates as well as no opening fees to start a savings account. Stocks, such as health and technology are also currently going up. Billy should start by saving small amounts of money per week for two years and placing it in a savings account. He should also buy health and tech stocks, such as Johnson & Johnson (JNJ) and International Business Machines Corporation (IBM), and keep a diversified portfolio, along with buying bonds.

On May 4, 2017 at approximately 9:34PM I, Deputy George along with Sergeant Kincaid were in the process of conducting an investigation regarding a possible disturbance in front of the address of 398 County Road 4249, Como, Texas 75432.

The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body systems, which included all required elements. Medical decision making was of moderate complexity.

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

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

I was happy that I managed to rule out any distinct causes of the abdominal pain by performing the examination to collect data, analyse it, and use the results to make an appropriate decision (Schon, 1984). However, had I performed the examination without assistance I may not have gained all the information required to confirm diagnosis, as I did forget some aspects.

I believe that it´s the same offender in the Parkinson case and the Johnson case, which is making the offender a serial killer because he has killed 3 people and it has been over a period over 30 days. By looking at different serial killer typologies my firm belief is that this offender will fall into the lust serial killer typology. I concluded this by firstly looking if the crimes were act-focused kills or process kills, I concluded it was process kills because the offender had taken the time to abduct both Parkinson and Johnson and didn 't just kill them right away like an act-focused killer would do. With the offender being a process killer he could only be organized as well because process killers cannot be disorganized. The offender would either be a lust killer, power-control killer or a thrill killer. I concluded that the offender in this case would not be a thrill serial killer, since this kind of murderer gets off my seeing his victims suffering, which is the most important factor for this type of offender. In the Parkinson and Johnson murders there were no signs of torture on the victims bodies and therefore I do not believe that this offender would be a thrill serial killer.

I. Introduction: It is estimated that approxiamately 10 to 20 percent of the population in the United States and Western Europe are currently being affected by Gallbladder attacks.