PA Alford's Case Summary

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

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

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

Ms. Fuhrman was complaining of pain to the abdomen and nausea when Dr. Babar first saw her. A CT scan was ordered and a GI consultation requested. It was the following day that she and Dr. Wang saw Ms. Fuhrman together, however the results of the CT were not available at that time. As the CT was not a stat order she had no reason to be concerned about them not be available at that point.

¬¬Donald Marshall Jr championed the fight for Mi’kmaq fishing rights in Nova Scotia. In 1993 Marshall was confronted by RCMP while fishing eel out of season with no license and selling the catch for profit. This lead to a court case defending the right to fish as a means of self-sustainment for all Mi’kmaq, which he pointed out was outlined within his treaty rights with the crown. This was a historical victory for indigenous people across Canada. Law passed as a result of the supreme-court case known as the Martial decision, which recognized that Mi’kmaq in Nova Scotia were guaranteed right to fish and hunt across the province as to survive and make a living as it is stated in the Peace and Friendship treaties of the 1700’s.

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

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

Based on the medical report dated 04/14/16, the patient presents for medication maintenance. He reports ongoing pain, withdrawal symptoms such as increased pain,

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

Telephone contact made to the patient. Two patient verifier completed. The patient states that on last Friday, Jan 8. she recieved a small pox vaccination to her left on arm. The patient state a couple day later she starts having pain in her left armpit and to the top of her left breast with very mild swelling. The patient rates her pain level 7/10 and is constant. She denies, lump or mass with palpated. She also denies, reddness, fever, chill, change in deodrant or body wash. The patient states that she has an appt sheduled with he provider on next Tuesday, Jan 19 but like to be seen sooner. Offered the patient an appt with Major Blount for today at 1420 or 1440 but the patient refused due to a meeting. Encourage the patient to keep

I s/w Dr.Kim he will see pt at rad dept pt is there now for Paracentesis he is waiting for a room s/w nurse at PIH she will contact Dr.Kim once Pt is in a room. Also I s/w sister Teresa whom stated pt has been declining for the past week c/o confusion, nausea, loa, abd pain also states patient is on lactulose.

The second identified area where the process broke down was when the patient’s family called the hospital to tell them that she was having emesis and severe pain rated nine out of ten. The triage nurse instructed them to take Tylenol and informed them that the physician was unavailable. The physician eventually called back and instructed them to give her one Tylenol and some soup. In this stage, the physician downplayed the concerns and did not consider the possibility of pancreatitis, the most frequent complication after having had an ERCP (Johnson, Haskell, & Barach, 2016, p. 80). The

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.

He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy.

Abdominal pain is commonly experienced by individuals along the age continuum and presents with symptoms that may be vague in nature. A thorough assessment of the patient including, a history of their symptoms and a physical exam are imperative for a timely diagnosis. The condition may range from acute to chronic depending on the cause. Abdominal pain ranks second to chest pain as the most common need for presentation to the emergency department in individuals ranging from ages 15 and older (Purysko et al., 2011). The presentation