Assessment of Abdominal Pain

Abdominal Assessment

A 65-year-old African American presents to the emergency department with a two days history of intermittent epigastric abdominal pain radiating from the back. Following an assessment, he was diagnosed with abdominal aortic aneurysm (AAA) but the doctor ordered a CTA scan. However, diagnosis of abdominal pain is a time-consuming and challenging process that can result in misdiagnosis if not conducted properly. The doctor’s recommendation of a CTA scan is geared towards ensuring a proper diagnosis of the patient’s condition. In addition to the recommended CTA scan, it is critical to review the patient’s history, physical exams, and diagnostic tests. This paper examines the patient’s abdominal assessment presented in the Episodic note case study in order to formulate a differential diagnosis of his condition.

Current Assessment

The Episodic note case study provides subjective and objective data collected from the patient that resulted in the AAA diagnosis. The current assessment is supported by the subjective and objective information presented in the case study. Prior to conducting any diagnostic tests, the healthcare provider obtained information relating to the history of present illness, past medical history, family history, and social history. Insights obtained from the subjective data was used as the premise for conducting the physical exam in order to obtain objective information. The use of subjective data to guide the physical exam demonstrates that the current assessment is supported by subjective and objective information.

However, the healthcare practitioner should have obtained additional information about the patient’s condition. The collection of subjective data should have included a review of systems/symptoms, particularly those relating to the location of the pain. According to Cartwright & Knudson (2008), the location of pain has significant predictive value when collecting subjective data on abdominal pain. When collecting information on the history of present illness, the physician should have considered conditions of the abdominal wall. Information on aggravating and alleviating factors would also be necessary to obtain from the patient. In addition, surgical history and history of hospitalizations would be necessary to collect from the patient.

Moreover, the assessment of the patient’s condition could have benefitted from additional physical examinations. Physical exams that would be necessary for this patient include an evaluation of gastrointestinal and urinary symptoms. Symptoms of gastrointestinal tract diseases would also be necessary for this patient because most of these conditions can present with abdominal pain (Macaluso & McNamara, 2012).

Diagnostic Tests

As shown in the Episodic note case study, two diagnostic tests (ultrasonography and CTA scan) were carried out on the patient and used to reach conclusions regarding the current diagnosis. Cartwright & Knudson (2008) state that the two diagnostic tests are the most commonly employed imaging tests for abdominal pain assessment. A simultaneous amylase and lipase measurement would be appropriate for this case since they are the recommended assessments for patients with epigastric pain (Cartwright & Knudson, 2008). These diagnostic tests would examine the levels of enzymes produced by the pancreas. Higher enzyme levels would be indicators of inflammation or infection in the pancreas. The results of amylase and lipase would help to determine whether the patient is suffering from pancreatitis.

Current Diagnosis for the Patient

The current assessment resulted in three differential diagnoses for the patient’s condition i.e. abdominal aortic aneurysm (AAA), perforated ulcer, and pancreatitis. I would accept the current diagnosis since it is supported by subjective and objective information relating to the patient’s symptoms and condition. AAA and pancreatitis are probable diagnoses of the patient’s condition since they are conditions that are usually characterized by pain in the epigastric area of the abdomen. AAA diagnosis could be appropriate in this case because of the patient’s symptoms and a 20-year history of smoking. The patient could be diagnosed with pancreatitis because the abdominal pain could be caused by inflammation of the pancreas. Perforated ulcer diagnosis could be appropriate for the patient’s condition if the abdominal pain is caused by damage to the stomach lining by a bacterial infection or current medication.

Differential Diagnosis

One of the differential diagnoses for the patient’s condition is peptic ulcer disease, which tends to affect individuals aged 50 years or more and is characterized by severe epigastric pain and epigastric tenderness (Mehta, 2016). Some of the risk factors for this condition include a history of smoking and current medications like non-steroidal anti-inflammatory drugs (NSAIDs). This would be a probable differential diagnosis for the patient because of his severe epigastric pain, history of smoking, and current medication i.e. Metoprolol 50mg. The second differential diagnosis for this patient is aortic dissection, which is a serious condition in which a tear occurs in the aorta (Cartwright & Knudson, 2008). The patient could be diagnosed with this condition because of the severe epigastric pain that radiates to the back and smoking history. Bowel obstruction is the other differential diagnosis that could be applicable to the patient because of severe epigastric pain, epigastric tenderness, and vomiting (Macaluso & McNamara, 2012).