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.
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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