Reference no: EM133910158

Question

Jane is a 15-year-old female being seen by her PCP for complaint of abdominal pain and vomiting. The abdominal pain is periumbilical, started 12-hours prior, and pain scale: 9 out 10. Her abdominal pain is described as constant, dull, and achy in nature. The pain is aggravated by walking and changing positions. Jane's mother gave her acetaminophen, which did not reduce her pain, but diminished pain noted only by lying supine. Jane refused to eat as she is not hungry and did have one episode of non-bilious emesis 2-hours after the onset of pain. She reports one small, loose bowel moment. Jane denies dysuria, urinary frequency, and her last menses was a week ago, which was normal. She denies having sexual contact. Physical Exam: she appears uncomfortable, her HR>110 bpm, RR: 18, and a temperature: 100F (37C). Her lung fields are clear to auscultation bilaterally. Her abdominal examination reveals hypoactive bowel sounds, right rectus abdominis muscle rigidity, and tenderness to palpation, particularly in the periumbilical region. Her pelvic exam shows neither vaginal discharge nor cervical motion tenderness, but she has some abdominal tenderness with gentle bimanual palpation. She has pain at the right lower quadrant when she flexes the right thigh and extends the hip to place her leg into the stirrup for the bimanual examination. Lab: CBC WBC 14.0, 60% Segs, 15% Bands. UA 10-15 WBC, 15-20 RBC, no bacteria. Abdominal radiographs: Non-specific, no fecalith is seen.

Case Study Scenario: GI System

1. What are your differential diagnoses?

2. What is your actual diagnosis? How did you reach this diagnosis?

- Define this patient's diagnosis? Etiology?

- Discuss prevalence, incidence, signs/symptoms, and expected significant findings on physical exams

- What specific physical exam (the name of the PE) is indicated to screen for your diagnosis?

3. What diagnostic test(s) and lab (s) are indicated for this patient?

- Discuss this patient's lab results and radiology result?

- What are the implication of these results?

- What diagnostic test is the gold standard in this case scenario?

4. What intervention(s)/management would you implement for this patient?

- Be specific about management related to this diagnosis

5. Any medical and/or social referrals/consults?

6. What are the complications associated with your diagnosis? 7) What is your patient's prognosis?

8. What education and resources would you offer this family?

9. What follow-up managements are recommended?