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Case
In the case study, a patient comes to the emergency room with complaints of acute abdominal pain after eating at a local restaurant. The meal that the patient had at the restaurant is described an all-you-can-eat buffet. The pain is located in the right upper quadrant with accompanying bloating. This paper discusses the differential diagnosis, possible tests and interventions for this patient.
Differential Diagnoses
There are several differential diagnoses in this patient presenting with this form of pain. The likely diagnosis based on the provided history is pancreatitis. Other differential diagnoses for this patient include cholecystitis, cholelithiasis, and peptic ulcers. The presentation of a patient with pancreatitis is similar to what is described in the case study (McCance, 2002).
Pathological Process
Pancreatitis is a condition associated with the inflammation of the pancreas (McCance, 2002). Things such as gallstones and alcoholic intake cause the inflammation of this gland. In addition, the pancreas may be affected by trauma, bacterial infections and tumors. In the case study, the patient had gallstones that were forced down the bile duct with resultant injury to the pancreas through which the duct traverses (McCance, 2002). The food intake provoked the emptying of the gall bladder with resultant injury on the pancreas. Consequently, injury to the gland led to the pain that characteristically radiated to the back. The other differential diagnoses are guided by the position of the pain. Several organs located in this area such as the liver and the gall bladder could be affected.
Tests
A variety of tests is available to confirm the differential diagnoses suggested by the pain that the patient describes. The tests include a complete blood count with differential counts. This particular test is helpful in showing the nature of the condition and may help show whether it is an infective process. Additionally, the test shows the level of the various blood components. The other test that is important in making a diagnosis in this patient is the assay of pancreatic amylase in the blood (McCance, 2002). A complementary assay of pancreatic lipase would also be crucial in the making of the diagnosis. Other blood tests include an assay of C-reactive protein and the erythrocyte sedimentation rate. Radiological tests that assist in making the diagnosis for this patient include an abdominal ultrasound and an erect abdominal X-ray. Computed topography is a crucial test for the diagnosis of pancreatitis and ruling out other conditions in the differential diagnoses (Taourel, 2011).
Treatments and Interventions
After the confirmation of the differential diagnosis, the proper treatment for the condition follows (Losos & Mason, 2008). First, the patient should receive medication to relieve the abdominal pain. Proper analgesics include opioids and NSAIDs. The patient also needs adequate hydration in the outpatient department before admission. In addition, the cause of pancreatitis needs to be established and treated. If infective, antibiotics may be used to treat the condition (McCance, 2002).
The other interventions that may be useful in the case study include starving the patient and the insertion of a tube to the stomach. Additionally, the patient may require endoscopic retrograde cholangiopancreatography (ERCP) in the event that the pancreatic ducts are blocked by biliary sludge or gallstones. The other intervention is dietary advice for the patient to prevent future incidents. Reduced fat intake is crucial in preventing future attacks.
References
Losos, J., & Mason, K. (2008). Biology (8th ed.). Boston: McGraw-Hill Higher Education.
McCance, K. (2002). Pathophysiology: The biologic basis for disease in adults & children (4th ed.). St. Louis: Mosby.
Taourel, P. (2011). CT of the acute abdomen. Berlin: Springer.
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