Abdominal Assessment: History, Exams, and Differential Diagnosis
This paper presents a clinical assessment of a 47-year-old male patient presenting with abdominal pain and diarrhea lasting three days. The paper identifies key patient history elements to collect, including medication side effects, prior gastrointestinal bleeding, stress levels, and alcohol consumption. It then outlines appropriate physical examinations and diagnostic tests—including CT scan, endoscopy, blood work, and skin testing—before proposing three differential diagnoses: peptic ulcer disease, an adverse reaction to metformin, and a reaction to lisinopril. The paper concludes that peptic ulcer disease is the most probable diagnosis given the patient's history of GI bleeding, alcohol use, and stress-related hypertension.
- Patient Overview: Patient demographics, symptoms, and medical background
- History to Collect: Key questions to guide clinical history gathering
- Physical Exams and Diagnostic Tests: Recommended tests including CT scan and endoscopy
- Differential Diagnosis and Possible Conditions: Three ranked diagnoses with supporting rationale
- Conclusion: Peptic ulcer prioritized over diverticulitis diagnosis
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What makes this paper effective
- The paper follows a logical clinical reasoning structure—moving from subjective patient history to objective testing to differential diagnosis—mirroring real-world clinical documentation practice.
- It draws meaningful connections between the patient's background (prior GI bleed, alcohol use, stress) and the proposed diagnoses, demonstrating integrative thinking rather than isolated symptom matching.
- The author appropriately challenges the presumed diagnosis of diverticulitis, using evidence-based reasoning to argue that ulcer disease deserves priority investigation, which shows critical clinical judgment.
Key academic technique demonstrated
The paper demonstrates differential diagnosis reasoning—a core clinical skill in which multiple competing explanations for a patient's symptoms are systematically evaluated and ranked by likelihood based on the patient's history, risk factors, and test results. This technique is supported by peer-reviewed citations for each proposed condition.
Structure breakdown
The paper opens with a patient overview establishing subjective and objective findings, then addresses history collection and its rationale, followed by recommended physical exams and diagnostics. The final substantive section proposes and ranks three differential diagnoses with supporting reasoning. A brief references list closes the paper. Five sections total, progressing from data gathering to clinical interpretation.
Patient Overview
The patient is a 47-year-old male presenting with a chief complaint of stomach pain and diarrhea, from which he has been unable to obtain relief. His abdominal pain began three days earlier, and he has taken no medication for it. The pain is currently at a midrange level, though it was very intense at onset today. He ate but experienced nausea afterward. The patient has a history of hypertension, type 2 diabetes, and a gastrointestinal (GI) bleed four years ago. He is currently on multiple medications to manage his blood pressure and diabetes, and has no known drug allergies and no history of colon cancer.
His father and mother both had hypertension; his father has type 2 diabetes; his mother suffered from gastroesophageal reflux disease and hyperlipidemia. The patient occasionally drinks alcohol. He is overweight at 248 lbs with a height of 5'10". On examination, he has a regular heart rate, soft and hyperactive bowel sounds, and pain in the left lower quadrant.
History to Collect
A history of how long the patient has been taking his current medications should be obtained. Metformin is one drug he is taking for diabetes, but one of its known side effects is diarrhea. If the patient has only recently begun taking this drug, his body could be having an adverse reaction to it (Dujic et al., 2016).
Whether diverticulitis runs in his family is a question that should also be asked, as this is the presumed diagnosis. However, additional information should be collected, such as the circumstances surrounding his GI bleed four years ago. Specifically, what caused the bleed should be explored: was it caused by peptic ulcers, which are a common cause of GI bleeding, or was it caused by enlarged veins in the esophagus that ruptured? If the patient has a history of peptic ulcers, an ulcer could reasonably be considered a differential diagnosis in this case, since stomach ulcers can cause cramps and pain in the lower abdomen.
Questions about stress levels should also be asked, as stress can inflame an ulcer and worsen symptoms over time (Mustafa et al., 2015). If the patient is experiencing significant stress at work or at home, an ulcer could be bleeding more, causing sharp stomach pains. Asking whether he experienced unusual stress or anxiety on the day of symptom onset or the day before would help inform the differential diagnosis.
Since the patient reports occasional alcohol consumption, there may be a link between his alcohol intake and his symptoms if an ulcer is indeed the cause of the pain. A question about when he last consumed alcohol and how much he has consumed over the past week would help establish a possible connection between alcohol use and his current symptoms.
Physical Exams and Diagnostic Tests
The patient should be evaluated for adverse reactions to his current hypertension medications. Allergic reactions to lisinopril are uncommon, but the drug can cause abdominal pain (Rastogi et al., 2018). Amlodipine may also cause stomach discomfort. Similarly, metformin, along with lisinopril and other medications, could be contributing to his gastrointestinal symptoms.
A CT scan of the abdomen should be conducted to test for diverticulitis. Blood tests, urine tests, and stool tests should also be performed to support a complete diagnosis. An endoscopy should be conducted to examine the stomach and small intestine and to look for ulcers; a biopsy may be ordered if ulcers are detected. A skin test could additionally be conducted to assess whether any of the patient's medications are producing an allergic response.
Conclusion
The patient's presentation—combining a history of GI bleeding, alcohol use, stress-related chronic conditions, and current polypharmacy—requires a thorough and systematic diagnostic workup. While diverticulitis is the presumed diagnosis, the clinical picture supports a careful investigation of peptic ulcer disease as the primary differential, followed by assessment of potential medication-related reactions. A CT scan, endoscopy, and targeted laboratory tests are the recommended next steps to reach an accurate diagnosis and appropriate treatment plan.
References
Dujic, T., Causevic, A., Bego, T., Malenica, M., Velija-Asimi, Z., Pearson, E. R., & Semiz, S. (2016). Organic cation transporter 1 variants and gastrointestinal side effects of metformin in patients with Type 2 diabetes. Diabetic Medicine, 33(4), 511–514.
Mustafa, M., Menon, J., Muiandy, R. K., Fredie, R., Sein, M. M., & Fariz, A. (2015). Risk factors, diagnosis, and management of peptic ulcer disease. Journal of Dental and Medical Sciences, 14, 40–46.
Rastogi, V., Singh, D., Mazza, J. J., Yang, D., Parajuli, D., & Yale, S. H. (2018). Flushing disorders associated with gastrointestinal symptoms: Part 2, systemic miscellaneous conditions. Clinical Medicine & Research, cmr-2017.
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