Clinical Correlation: Abdomen
A 55 y.o female with a 10 year history of poorly controlled diabetes mellitus presents with sudden onset of RUQ pain. She states the pain 6 out of 10 in severity, and is sharp to burning in nature. It is constant and radiates around to her back. She reports no nausea or vomiting, or change in her bowel habits. She denies any change with food intake.
What is your differential for this woman’s RUQ pain?
What signs would you look for on physical exam?
A 45 y.o. male with a significant ETOH abuse history comes into the E.D. with sudden onset of midepigastric pain. He states he had hurt his back recently lifting some papers but this pain is different. It is 10/10 and burning in nature. It “bores” through to his back. Initially, it was only present when he began to eat but now it is constant. He feels slightly nauseated but has not vomited. He did note that recently his stools had turned to a “tarry” color and consistency.
What is this patient’s most likely diagnosis? Be specific.
How would you initially treat him?
Shortly after admitting him he was noted to vomit bright red blood. His blood pressure began to drop and his pulse rate increased. What do you hypothesize may have occurred?
A 42 y.o. woman who is six weeks post partum presents with recurrent RUQ pain. She states that she has had “attacks” like this in the past but it is now becoming more severe. She describes her pain as 4-7/10, “colicky” and worsened after some meals. The pain radiates to her right scapula. She has nausea but has not vomited. Her stools have not changed color but had been black shortly after the delivery of her child.
What is the likely cause of this woman’s pain and what kind of study might aid you in confirming your diagnosis?
What might her meals contain that seem to exacerbate her symptoms? Why?
The patient undergoes a procedure to remedy her disease process. However, she returns 6 weeks later with severe midepigastric pain, fevers, and persistent nausea and vomiting. What happened?
A 45 y.o.m. presents to your office for the first time complaining of a “swollen belly.” He has noted it increasing in size over the last four months. He denies any alcohol usage but states he did “experiment with drugs” back in the late ‘70’s. On exam, he appears cachectic and his sclera are mildly icteric. You note he has gynecomastia and dilated blood vessels on his abdomen. His abdomen is protuberant and when you percuss it you get dull sounds in the flanks bilaterally.
What is going on in his abdomen and why?
What is/are the mechanisms for the development of his abnormal physical findings? Can you think of any other findings on your exam that might occur as a result of his disease?
A 66 y.o. general surgeon comes into the E.D. from a local restaurant with the “worst pain of my life.” He states he developed severe, constant, sharp pain about 20 minutes after eating his meal. He is writhing on the gurney from his pain. However, when you perform your physical exam his abdomen is soft, with slightly diminished bowel sounds but non-tender throughout and without any periumbilical pulsatile masses.
What do you think is going on with this gentleman and what would you want to know about his past medical history?