Abdominal Aortic Aneurysm: Differential Diagnosis Assessment
This paper analyzes the abdominal assessment of a 65-year-old African American male presenting to the emergency department with two days of intermittent epigastric pain radiating to the back. Using an episodic note case study, the paper evaluates the subjective and objective data that led to a working diagnosis of abdominal aortic aneurysm (AAA). It critiques the current assessment by identifying gaps in history-taking and physical examination, discusses the appropriateness of ultrasonography and CTA scanning, and proposes three additional differential diagnoses—peptic ulcer disease, aortic dissection, and bowel obstruction—supported by the patient's clinical presentation, smoking history, and current medications.
- Introduction: Case overview and paper purpose
- Current Assessment: Subjective, objective data and assessment gaps
- Diagnostic Tests: Imaging and enzyme tests evaluated
- Current Diagnosis: AAA, pancreatitis, perforated ulcer discussed
- Differential Diagnosis: Peptic ulcer, aortic dissection, bowel obstruction
- Conclusion: Comprehensive assessment key to accurate diagnosis
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What makes this paper effective
- The paper systematically moves from subjective data collection to objective findings and then to differential diagnosis, modeling a clinically logical workflow that mirrors real emergency department practice.
- It critically evaluates what was done well and what was missing in the assessment (e.g., absence of a full review of systems, surgical history), demonstrating analytical rather than purely descriptive thinking.
- Each differential diagnosis is anchored to specific patient details—age, smoking history, current medications, and symptom location—making the reasoning concrete and evidence-based.
Key academic technique demonstrated
The paper uses citation-supported clinical reasoning to justify each diagnostic and procedural recommendation. Rather than asserting conclusions, the author ties each claim to peer-reviewed sources (Cartwright & Knudson, 2008; Macaluso & McNamara, 2012; Mehta, 2016), demonstrating how evidence-based practice guides clinical decision-making.
Structure breakdown
The paper follows a clear five-part clinical structure: (1) an introduction framing the diagnostic challenge, (2) a critique of the current assessment's subjective and objective data, (3) an evaluation of diagnostic imaging and lab tests, (4) acceptance and justification of the working diagnosis, and (5) three alternative differential diagnoses with supporting rationale. A brief conclusion synthesizes the importance of comprehensive assessment in emergency abdominal pain cases.
Introduction
A 65-year-old African American male presents to the emergency department with a two-day history of intermittent epigastric abdominal pain radiating to the back. Following an assessment, he was diagnosed with abdominal aortic aneurysm (AAA), and the physician ordered a CTA scan. However, diagnosing abdominal pain is a time-consuming and challenging process that can result in misdiagnosis if not conducted properly. The recommendation of a CTA scan is geared toward ensuring an accurate diagnosis of the patient's condition. In addition to the CTA scan, it is critical to review the patient's history, physical examination findings, and diagnostic test results. 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 both 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 were used as the basis for conducting the physical examination in order to gather objective information. The use of subjective data to guide the physical exam demonstrates that the current assessment is grounded in both 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 full review of systems and symptoms, particularly those relating to the location of the pain. According to Cartwright and Knudson (2008), the location of pain has significant predictive value when collecting subjective data on abdominal pain. When documenting the history of present illness, the physician should also have considered conditions of the abdominal wall. Information on aggravating and alleviating factors would likewise be necessary to obtain from the patient, as would surgical history and any prior hospitalizations.
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. Assessment for signs of gastrointestinal tract disease would also be warranted because most such 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 and Knudson (2008) note that these are the most commonly employed imaging tests for abdominal pain assessment. A simultaneous amylase and lipase measurement would also be appropriate for this case, as these are the recommended assessments for patients presenting with epigastric pain (Cartwright & Knudson, 2008). These tests examine the levels of enzymes produced by the pancreas; elevated enzyme levels indicate inflammation or infection in the pancreas. The results of amylase and lipase measurements would help determine whether the patient is suffering from pancreatitis.
Conclusion
This scenario demonstrates some of the complexities physicians face in the assessment and diagnosis of abdominal pain. The complexity is partly attributable to the fact that abdominal pain is one of the most common reasons for visits to the emergency department. As evident in the case study, proper diagnosis of abdominal pain requires a comprehensive assessment of a patient's history and presenting symptoms. Insights obtained from subjective data should be utilized to guide the physical examination. Physicians should conduct a detailed review of both subjective and objective information in order to select the appropriate diagnostic tests for a patient's condition. A comprehensive review of subjective and objective data ultimately results in a more accurate diagnosis for a patient presenting with abdominal pain.
References
Cartwright, S. L., & Knudson, M. P. (2008). Evaluation of acute abdominal pain in adults. American Family Physician, 77(7), 971–978.
Macaluso, C. R., & McNamara, R. M. (2012). Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine, 5, 789–797.
Mehta, H. (2016). Abdominal pain. Clinical Pathways in Emergency Medicine, 1, 329–345. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121692/
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