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Case Study Of Patient With Epigastric Pain Essay Paper

Case Study Of Patient With Epigastric Pain Essay Paper

Additional subjective Data

The patient is a 65-year-old African American male who presented with intermittent epigastric pain radiating to the back. He reports that the pain is not relieved by PPIs, has been increasing in severity over the past few hours, and has had an episode of post-prandial vomiting. He denies having diarrhea, vomiting, or other symptoms associated with abdominal pain. He is a known hypertensive on metoprolol 50mg. He has a positive family history of hypertension, GERD, and hyperlipidemia. He has had a positive history of ETOH and smoking for 20 years but quit both two years ago. LZ separated from his wife five years ago, and they have three living children, two males and one female. Case Study Of Patient With Epigastric Pain Essay Paper

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Ask the patient to describe the vomitus. Bloody vomitus is often a sign of a perforated ulcer, esophageal varices, or esophagitis. Vomitus that is coffee ground or black usually shows that the bleeding is from the lower GIT, whereas fresh blood is evidence of upper GIT. Bilious vomiting suggests small bowel obstruction, whereas vomiting feculent material indicates a large bowel obstruction. Regurgitation of undigested food is seen in achalasia of cardia, Zenker’s diverticulum, or esophageal stricture. Does nausea precede the vomiting? Projectile vomiting is often seen in cases of increased intracranial pressure (Heckroth et al., 2021)Case Study Of Patient With Epigastric Pain Essay Paper. Does the patient report hotness of the body? Fever with vomiting is often seen in cases of gastroenteritis.

Does the patient have symptoms of acid reflux? GERD occurs when the lower esophageal sphincters become weak leading to acid reflux and regurgitation (Antunes et al., 2022). Has the patient noticed any abdominal swelling? An epigastric hernia is caused by weakness of the abdominal muscles leading to symptoms of abdominal pain and vomiting when it is strangulated. In the review of the system, does the patient have retrosternal pain, chronic cough, or hoarse voice? These symptoms are often associated with GERD.

Additional objective Data

The objective portion shows that the patient is obese and all the vital signs except the blood pressure level are within the normal range. The BP shows that the patient is going into hypotension. Random blood sugar is also an important vital sign given that the patient is obese. There were no abnormal findings on the systemic examination except epigastric tenderness with guarding. Additional information on the general examination findings, such as if the patient is jaundiced or has parlor, is essential. Abdominal examination parameters should include; any obvious skin color changes? Is there bruising around the flank, umbilicus, and inguinal ligament? They all point out retroperitoneal hemorrhage, which presents with a bluish discoloration (Mealie et al., 2021)Case Study Of Patient With Epigastric Pain Essay Paper. What is the note on percussion, and are the bowel sounds present?

Assessment Appropriateness

The assessment is mainly supported by the subjective portion that focuses on the patient’s history and clinical presentation. The objective portion does not have adequate information as it only reveals obesity and epigastric pain with guarding.

Appropriateness of Diagnostic Test

Both abdominal ultrasound and CT scan are essential in looking for abnormalities within the abdominal cavity.

  • Serum amylase and lipase: assess the exocrine function of the pancreas.
  • Liver function tests: check the AST, ALT, and AP levels.
  • Random blood sugar: check the glucose levels
  • Kidney function tests: assess the urea, creatinine, and electrolyte levels to rule out an acute kidney injury.
  • Complete blood count: check the leucocyte count and its differentials to rule out infection and the hemoglobin level for evidence of anemia.
  • Lipid profile: to rule out hyperlipidemia.
  • Inflammatory markers: ESR and CRP levels to check for evidence of inflammation or infection.
  • Erect abdominal x-ray: to check for air under the diaphragm, which points to a perforated peptic or duodenal ulcer.
  • Endoscopy: look out for upper GI anomalies.
  • Chest x-ray: to check for a left pleural effusion, a cardinal sign of pancreatitis. Case Study Of Patient With Epigastric Pain Essay Paper

Is the Current Diagnosis Acceptable?

The diagnosis of acute pancreatitis is acceptable. The patient has the classic presentation of epigastric pain that radiates to the back associated with vomiting, which is post-prandial. A common finding in patients with acute pancreatitis is hypotension due to inflammation and cytokine storm leading to endothelial injury and increased vasculature permeability, causing fluid leakage into the retroperitoneal space (Nabeeha Mohy-ud-din & Morrissey, 2021). He has predisposing risk factors such as a history of alcohol use and is obese therefore putting him at risk of hyperlipidemia, a common risk factor. I would also agree with the diagnosis of a perforated peptic ulcer which mostly presents with sudden onset epigastric pain associated with vomiting. I would, however, reject the diagnosis of an abdominal aortic aneurysm. Shaw et al. (2022) state that most AAA is asymptomatic and often goes unnoticed unless it ruptures. It is noted on physical examination where it presents with a pulsatile and non-tender abdominal mass.

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Differential Diagnosis

GERD (K21.9): occurs when there is reflux of gastric contents back into the esophagus, causing symptoms of epigastric pain, acid reflux, dysphagia, and nausea. The causes associated with GERD include; increased intra-abdominal pressure as seen in obesity, impairment of the lower esophageal sphincter tone, delayed gastric emptying, esophageal dysmotility, transient lower esophageal stricture relaxation, and presence of a hiatal hernia (Antunes et al., 2022). Other independent risk factors associated with GERD include; excess alcohol intake age >50 years, tobacco use, and intake of medications such as aspirin, NSAIDs, calcium channel blockers, and benzodiazepines.

Acute gastritis (K29.0) is a disease that causes inflammation of the stomach wall lining. H.pylori infection is the most common cause of gastritis globally. Other causes include; excessive alcohol consumption, tobacco smoking, radiotherapy, and use of NSAIDs or steroid medications (Azer & Hossein Akhondi, 2022). The clinical manifestation consists of; sudden onset epigastric pain, heartburn, bloating, nausea and vomiting.

Acute gastroenteritis (AO9.9): a condition that causes inflammation of the stomach and small and large intestine, resulting in symptoms of abdominal pain, nausea, vomiting, and diarrhea. Most of the causes are infectious agents that include viral or bacterial causes (Hasan et al., 2021)Case Study Of Patient With Epigastric Pain Essay Paper. Other causes include; medications such as antibiotics and toxic ingestions like organophosphates.

References

Antunes, C., Aleem, A., & Curtis, S. A. (2022, May 4). Gastroesophageal Reflux Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441938/

Azer, S. A., & Hossein Akhondi. (2022, May). Gastritis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544250/

‌ Hasan, H., Nasirudeen, N. A., Ruzlan, M. A. F., Mohd Jamil, M. A., Ismail, N. A. S., Wahab, A. A., & Ali, A. (2021). Acute Infectious Gastroenteritis: The Causative Agents, Omics-Based Detection of Antigens and Novel Biomarkers. Children, 8(12), 1112. https://doi.org/10.3390/children8121112

Heckroth, M., Luckett, R. T., Moser, C., Parajuli, D., & Abell, T. L. (2021). Nausea and Vomiting in 2021. Journal of Clinical Gastroenterology, 55(4), 279–299. https://doi.org/10.1097/mcg.0000000000001485

‌ Mealie, C. A., Ali, R., & Manthey, D. E. (2021, October 15). Abdominal Exam. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459220/#

Shaw, P. M., Loree, J., & Gibbons, R. C. (2022, May 8). Abdominal Aortic Aneurysm. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470237/

Nabeeha Mohy-ud-din, & Morrissey, S. (2021, July 12). Pancreatitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538337/ Case Study Of Patient With Epigastric Pain Essay Paper

‌CC: “My stomach has been hurting for the past two days.” HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain. PMH: HTN Medications: Metoprolol 50mg Allergies: NKDA FH: HTN, Gerd, Hyperlipidemia Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female Objective: VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs Heart: RRR, no murmurs Lungs: CTA, chest wall symmetrical Skin: Intact without lesions, no urticaria Abd: abdomen is tender in the epigastric area with guarding but without mass or rebound. Diagnostics: US and CTA Assessment: Abdominal Aortic Aneurysm (AAA) Perforated Ulcer Pancreatitis. Review this week’s Learning Resources, and consider the insights they provide about the case study. Consider what history would be necessary to collect from the patient in the case study. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. Case Study Of Patient With Epigastric Pain Essay Paper

The Assignment Analyze the subjective portion of the note. List additional information that should be included in the documentation. Analyze the objective portion of the note. List additional information that should be included in the documentation. Is the assessment supported by the subjective and objective information? Why or why not? What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis? Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature..

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 6, “Vital Signs and Pain Assessment”

This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.

Chapter 18, “Abdomen”

In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby. Case Study Of Patient With Epigastric Pain Essay Paper

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 3, “Abdominal Pain”

This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.

Chapter 10, “Constipation”

The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.

Chapter 12, “Diarrhea”

In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.

Chapter 29, “Rectal Pain, Itching, and Bleeding”

This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.

Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)Case Study Of Patient With Epigastric Pain Essay Paper

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

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Chabok, A., Thorisson, A., Nikberg, M., Schultz, J. K., & Sallinen, V. (2021). Changing paradigms in the management of acute uncomplicated diverticulitis. Scandinavian Journal of Surgery, 110(2), 180–186. https://doi.org/10.1177/14574969211011032

Hussein, A., Arena, A., Yu, C., Cirilli, A., & Kurkowski, E. (2021). Abdominal pain in the elderly patient: Point-of-care ultrasound diagnosis of small bowel obstruction. Clinical Practice and Cases in Emergency Medicine, 5(1), 127–128. https://doi.org/10.5811/cpcem.2020.11.50029

please have someone wirte it who is familiar with nursing 6512. Case Study Of Patient With Epigastric Pain Essay Paper