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 increasin

Assessing the Abdomen and Gastrointestinal System

Question One: Analysis of the Subjective Portion

The patient is a 65-year-old African American male with intermittent epigastric pain that radiates to the back and is not relieved with PPI use. He also experienced vomiting after a meal. Also, he is a hypertensive patient on metoprolol. His family history is significant of GERD, hyperlipidemia, and HTN. He has a history of alcohol and smoking but quit both two years ago.

Additional information that should be included in the documentation for subjective data is information on the eating pattern of the patient before developing the symptoms, including the quantities of food taken and types of food. Information on when the epigastric pain is often felt may help in the diagnosis. The patient should be asked whether the pain worsens on lying down. A history of NSAID use should also be interrogated. Long-term NSAID use has been implicated in gastrointestinal disorders.

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Question Two: Analysis of the Objective Portion

The patient had a temperature of 98.2 degrees, BP of 91/60 mmHg, RR of 16 breaths per minute, PR 76 beats per minute, HT of 6’10”, and WT 262 lbs. The patient had a regular heart rate and rhythm, no murmurs, and a symmetrical chest wall. Abdominal examination revealed tenderness in the epigastric region with guarding but without rebound or mass. Additional information on physical examination documentation is information on the presence of anemia. The caregiver should assess for signs of anemia in the patient. The healthcare provider should also assess for fatigue, dental erosion, and dysphonia. Another piece of information that may be obtained by physical examination is the presence of a productive cough. Bloodstain cough and stool are often indicative of mucosal perforations that characterize some gastric pathologies.

Question Three: Assessment

Assessment findings revealed pancreatitis, abdominal aortic aneurysm, and perforated ulcer as likely etiologies for the patient’s presentations. These assessment findings are, to a small extent, supported by subjective and objective information. The patient presented with epigastric pain that radiates to the back and is not relieved with PPIs and an episode of vomiting. Acute pancreatitis commonly presents with epigastric abdominal pain that also radiates to the back. Acute pancreatitis is also associated with nausea and vomiting. This warrants the admission of this assessment finding.

The assessment finding for an aortic aneurysm was not warranted in this case. While abdominal aortic aneurysm sometimes presents with abdominal and back pain, the pain is often sudden in onset. Palpation of the abdomen in an aortic aneurysm also reveals a non-tender and pulsatile abdominal mass. In the case above, the palpation revealed a tender abdomen, thus warranting the exclusion of this assessment.

The assessment finding for perforated ulcers is also not warranted in this case. Perforated ulcers often result in internal bleeding. This can be indicated by the presence of hematemesis, melena stool, fatigue, noticeable heartbeats, and shortness of breath (Malik et al., 2022). None of these were observed during the patient’s physical examination. The patient’s manifestation did not indicate the presence of a perforated ulcer, thus warranting the exclusion of this assessment.

Question Four: Appropriate Diagnostic Tests

The most appropriate diagnostics for the patient include an abdominal ultrasound and computed tomography of the abdomen. Abdominal ultrasound is an effective tool in the diagnosis of pancreatitis. This diagnostic tool helps in the detection of choledocholithiasis and the dilation of the bile duct. CT scan is also recommended where the patient’s manifestation fails to improve after a period of sustained fluid resuscitation or when the presentations are equivocal. Essentially, CT scans enable the detection of parenchymal changes seen in pancreatitis and can thus help in confirming the disease.

Question Five: Analysis of the Current Diagnosis and Differential Diagnoses

The patient presentations are consistent with acute pancreatitis. Acute pancreatitis presents with epigastric abdominal pain and is commonly accompanied by vomiting. Pain observed in acute pancreatitis is sharp, severe, and persistent and is made worse by the assumption of the supine position (Chatila et al., 2019). This diagnosis is confirmed by the failure of PPIs to relieve the patient’s manifestations. PPIs maintain effectiveness in gastric disorders such as PUD and GE