Upper Abdominal Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍upper abdominal pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Location is ‍diffuseepigastric

Radiation ‍none to ‍back

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍hematemesis

‍heartburn

‍dyspepsia

‍dysphagia

‍bloating

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots

‍dark, tarry stools

‍flatulence

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath



Contributing factors:

‍heavy alcohol consumption

‍smoking

‍recent change in diet

‍high fat diet

no history of: ‍immunodeficiency, ‍gastric ulcer, ‍gallstones, ‍pancreatitis, ‍gastroesophageal reflux disease, ‍hiatal hernia

no use of: ‍NSAIDs, ‍oral steroids, ‍new medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Gastritis ‍likelysuspectedpossible

DDx: gastritis, peptic ulcer disease, pancreatitis, cholecystitis, hepatitis, myocardial infarction, functional abdominal pain, gastroenteritis, appendicitis, gallstones, inflammatory bowel disease, mesenteric ischemia, diverticulitis, small bowel obstruction, pneumonia with referred pain, diabetic ketoacidosis, abdominal aortic aneurysm, spleen rupture, herpes zoster, sickle cell crisis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍ß-hCG, ‍troponin, ‍H. pylori antibodies

- Urinalysis, urine culture

- Abdominal X-ray

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- Upper GI endoscopy

- Colonoscopy

- Stool tests: ‍FIT test, ‍calprotectine, ‍fecal pancreatic elastase

- ECG

Treatments:

- ‍PPIs

Further care:

- Referral to gastroenterologist

- Referral to general surgeon

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens or if new symptoms develop such as fever, vomiting, or blood in stools