Case Study – Gastrointestinal issues
Demographics
- Age: 22-year-old
- Gender: Female
Chief Complaint: Abdominal pain
History of Present Illness (HPI): The patient reports experiencing abdominal pain that started in the general abdomen but has migrated to the right lower quadrant. The pain is associated with nausea, vomiting, fever, rebound tenderness, and tenderness in the right lower quadrant. There is no mention of changes in bowel habits or blood in the stool.
Previous Medical History and Surgical History: No significant medical or surgical history is noted for the patient.
Allergies: None
Lifestyle: The patient’s lifestyle factors, such as diet, exercise habits, and stress levels, should be explored to identify potential contributing factors to gastrointestinal issues.
Analysis of Associated Risk Factors/Demographics: Given the patient’s age and gender, several risk factors contribute to the chief complaint. Young adults, particularly females, have an increased likelihood of certain conditions such as appendicitis and gynecological issues like ectopic pregnancy. Lifestyle factors such as diet, exercise habits, and stress levels could also play a role in gastrointestinal issues but are not explicitly mentioned in the provided information (Peery et al., 2022). Urgent evaluation and consideration of potential surgical intervention are warranted due to the severity and progression of symptoms.
Differential Diagnoses:
- Appendicitis:
- Pathophysiology: Inflammation of the appendix due to obstruction, leading to bacterial overgrowth and infection.
- Rationale: Classic symptoms include migrating abdominal pain, nausea, vomiting, fever, and localized tenderness, especially in the right lower quadrant (Peery et al., 2022).
- Diverticulitis:
- Pathophysiology: Inflammation or infection of diverticula, small pouches in the colon wall, typically due to fecal matter becoming trapped.
- Rationale: Symptoms may include left lower quadrant abdominal pain, fever, nausea, vomiting, and changes in bowel habits (Peery et al., 2022).
- Ectopic Pregnancy:
- Pathophysiology: Implantation of a fertilized egg outside the uterus, often in the fallopian tubes.
- Rationale: Symptoms can mimic appendicitis, with abdominal pain, nausea, vomiting, and potentially vaginal bleeding (Hendriks et al., 2020).
Differences Among Differential Diagnoses
First, appendicitis primarily affects the appendix, diverticulitis involves the colon, and ectopic pregnancy occurs in the reproductive organs (Peery et al., 2022). Further, appendicitis typically presents with right lower quadrant pain, while diverticulitis commonly presents with left lower quadrant pain (Peery et al., 2022). Lastly, ectopic pregnancy may present with vaginal bleeding, which is not typically seen in appendicitis or diverticulitis (Hendriks et al., 2020).
Relevant Testing
- For appendicitis and diverticulitis: CBC, CT scan (Peery et al., 2022).
- For ectopic pregnancy, CBC, urine pregnancy test, and transvaginal ultrasound (Hendriks et al., 2020).
National Guidelines: National guidelines recommend the use of imaging studies, such as CT scans, to aid in the diagnosis of appendicitis and diverticulitis (Peery et al., 2022). Urine pregnancy tests and ultrasound are recommended for diagnosing ectopic pregnancy (Hendriks et al., 2020). Early surgical intervention is often indicated for appendicitis to prevent complications.
References
Hendriks, E., Rosenberg, R., & Prine, L. (2020). Ectopic pregnancy: diagnosis and management. American Family Physician, 101(10), 599-606.
Peery, A. F., Crockett, S. D., Murphy, C. C., Jensen, E. T., Kim, H. P., Egberg, M. D., & Sandler, R. S. (2022). Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology, 162(2), 621-644. https://doi.org/10.1053/
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Question 
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Case study any patient with Gastrointestinal issues and complaints
The Chief Complaint will be 22-YEAR-OLD FEMALE WITH C/O ABDOMINAL PAIN: THAT MIGRATES TO THE RIGHT LOWER QUADRANT OF THE ABDOMEN, NAUSEA, VOMITING, FEVER, REBOUND TENDERNESS, right QUADRANT TENDERNESS,
Case Study – Gastrointestinal issues
DIFFERENTIAL DIAGNOSES WILL BE: APPENDICITIS, DIVERTICULITIS, ECTOPIC PREGNANCY, IBS ( IRRITABLE BOWEL SYNDROME
TEST/LABS
CBC
CT SCAN
URINALYSIS
FINAL DIAGNOSIS IS APPENDICITIS
SHE WILL BE REFERRED TO THE EMERGENCY ROOM TO HAVE AN
ANYTHING ELSE LIKE ALLERGIES NAD HISTORY SHOULD BE NONE