American Sentinel N522PE Module 4 Discussion 4

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Discussion 4

As you know, abdominal pain can be a challenging patient complaint because it is frequently benign, but can also herald serious acute pathology. American Sentinel N522PE Module 4 Discussion 4. The history and physical examination are critical to narrowing the differential diagnosis of abdominal pain and guiding the evaluation. Acute abdominal pain frequently requires urgent investigation and management. Some patients may require the assessment of their airway, breathing, and circulation, followed by appropriate resuscitation. Many patients will require analgesics, which can be administered judiciously without compromising the physical assessment of peritoneal signs. That said, what are the common differential diagnoses of abdominal pain in emergency situations? Also, does your healthcare institution have a specific policy, algorithm and/or protocol on how to assess, manage, and treat abdominal pain? Please share an example of the protocol for abdominal pain from practice or the literature.

Example Answer

A patient presenting to the clinic or emergency department with such a vague complaint as abdominal pain can lead to many different working diagnoses. Much depends on the location, intensity, when the pain started, the quality of the pain, aggravating factors, mitigating factors and age. Depending on the location of the pain will be the driving force for the specific workup to determine the cause of the abdominal pain. There appears to be several diagnostic tools that have commonality across the myriad of diagnoses for the complaint of abdominal pain. These include a complete blood count, a metabolic panel, urinalysis and a thorough abdominal examination by the healthcare provider (Bickle, 2017). The complete blood count not only assesses the presence of infection by having a high white blood count, but will also indicate if the pain is being caused by gastrointestinal bleeding. This is accomplished by calculating a hemoglobin and hematocrit count (Bickley, 2016). The metabolic panel will include electrolytes with amylase and lipase. This will determine if there is any liver, pancreas or gallbladder involvement (Bickley, 2017). Once the healthcare provider has determined the area of abdominal pain, a differential diagnosis can begin. Upper abdominal pain would include a differential of gallbladder disease, pancreatitis, gastritis, liver disease, perforated ulcer, GERD, hiatal hernia, and pneumonia. Lower abdominal pain would have a differential of appendicitis, small or large bowel obstruction, diverticulitis, Crohn’s disease, ulcerative colitis, colon cancer, ventral, umbilical or inguinal hernia strangulation, ovarian cysts, ectopic pregnancy or pelvic inflammatory disease in females. Diagnostic testing such as ultrasound and/or CT scans aid in the specific diagnosis.

Chong, Schultz and Donnelly (2019) noted that in Australia approximately 40% of the emergency departments have specific protocols for the treatment and diagnosis of abdominal pain. Gans et al. (2015) noted that there is a wide variation in emergency departments for the treatment of abdominal pain based on the fact that the workup is physician preference. American Sentinel N522PE Module 4 Discussion 4

References

Bickley, L. S., & Szilagyi, P. G. (2017). Bates guide to physical examination and history taking

(12th ed.). Wolters Kluwer.

Chong, V. Schultz, T. Donnelly, F. (2019) Clinical protocols for adults with acute abdominal pain in

Australian emergency departments. Journal of Evaluation of Clinical Practice 25(3) pp 412-419

Gans, S.L. Pols, M.A. Stoker, J. Boermeester, M.A, (2015) Guideline for the diagnostic pathway in

Patients with acute abdominal pain. Digestive Surgery 32(1) pp 23-31

400 words

Well done. Describe ominous signs of breast cancer on exam.

10 words

According to Dains, Baumann and Schiebel (2015), the two most prominent risk factors for breast cancer are age over 50, which accounts for 75% of diagnosis’ and being female. Other factors include previous cancer, positive cancer markers BRCA1 or BRCA2 and a family history of breast cancer (Dains, Baumann & Schiebel, 2015). Moore et al. (2016) noted that those from a lower socioecomic stratum have far worse outcomes mainly due to latter entry into the healthcare system and failure to follow through with treatments. Bickley (2016) reports that in a female over 50 any abnormal findings are indicative of breast cancer until proven otherwise. There appears to be some controversy concerning Self Breast Exams (SBE). The USPSTF does not advocate for SBE due to the fact that there is no effect on mortality, while the ACOG does however recommend SBE (Bickley, 2016).

Upon physical examination, a unilateral firm in natural is approximately 75% of being cancerous upon biopsy (Gains, Baumann, Schiebel, 2015). Some of the indications of breasts cancer during a physical examination include, convexity, dimpling, asymmetry of nipples, nipples pointing is different directions, depressed or inverted nipples, loss of nipple elasticity, breast tenderness, nipple discharge and color (Bickley, 2016).

References
Bickley, L. S. (2017). Bate’s guide to physical examination and history taking (12th
ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment & clinical diagnosis in primary care – E-book (5th ed.). Elsevier Health Sciences.
Moore, S.P. Soerjomataram, I. Green, A.C. Garvey, G. Martin, J. (2016). Breast cancer
diagnosis, patterns of care and burden of disease in Queensland, Australia (1998-2004):
does being Indigenous make a difference? International Journal of Public Health. 61(4)
. DOI:10.1007/s00038-015- American Sentinel N522PE Module 4 Discussion 4

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According to Cartwright and Knudson (2015), abdominal pain is the reason for office-based visits 1.5% of the time. Left lower quadrant pain can indicate sigmoid diverticulitis. This is seen in 5-10% of adults 45 years old or older and 80% of 80 years old and older (Hammond, Nikolaidis, & Miller, 2010). If a patient presents with left lower quadrant abdominal pain, fever and leukocytosis, the provider should assess for sigmoid diverticulitis. Computed tomography (CT) scans with contrast are the recommended radiological test for ruling in/out diverticulitis. Hammond, Nikolaidis and Miller also indicate that CT scans have a sensitivity of greater than 95% in detecting diverticulitis. The most common is uncomplicated diverticulitis. Complicated diverticulitis may reveal abscess, fistulas and possible perforation and usually requires surgical intervention. Treatment for uncomplicated diverticulitis is usually conservative. Complicated diverticulitis with small abscesses may be treated with antibiotics and bowel rest. Surgery is required for perforations and peritonitis (Baum & Companioni, 2019).
Baum, J and Companioni R. (2019). Colonic diverticulitis. Merk Manual. https://www.merckmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-diverticulitis
Cartwright, S., & Knudson, M. (2015). Diagnostic imaging of acute abdominal pain in adults. American Family Physician. 91(7), 452-459. https://www.aafp.org/afp/2015/0401/p452.html
Hammond, N., Nikolaidis, P., & Miller, F. (2010). Left lower quadrant pain: Guidelines from the American College of Radiology appropriateness criteria. American Family Physician. 82(7), 766-770. https://www.aafp.org/afp/2010/1001/p766.html

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American Sentinel N522PE Module 4 Discussion 4