Question

Case Scenario: “lapay”
Mr. Lopez, a 60 y/o teacher, presents with a history of a sudden onset of acute upper central abdominal pain radiating to his back. The nurse attending Mr. Lopez asked about how it started. He stated that “this morning after breakfast, I had sudden, severe pain in my abdomen and I vomited a couple of times, but the pain still persists. It hurts here, above my belly button, and feels like it goes
straight through to my back.”

On the client’s past medical history, he had an appendectomy at age 25 and tonsillectomy at 7. He was also diagnosed with hypertension 5 years ago and pre-diabetes 6 months ago. When asked about pertinent family history, he willingly disclosed that he had a sister, 45 yo, was diagnosed with cholelitihiasis 2 years ago, a brother who is 54 yo had a cholecysytectomy 5 years ago for acute
cholecystitis and cholelithiasis and mother who is 80 yo had also underwent cholecystectomy for acute cholecystitis and cholelithiasis 13 years ago.

Mr. Lopez admits to drinking whiskey most evenings but denied that he was never a smoker. The client also stated that he has no known allergies and currently taking Aspirin 325mg every day, Propranolol 30 mg every day and Hydrochlorthiazide 25 mg every day.

Upon PE, vital signs reveals a blood pressure of 110/60 mmHg, HR of 110 bpm, RR of 24 cpm, body temperature of 38.4 OC and a pain scale of 8 out of 10. Upon auscultation, no murmurs or extra cardiac sounds were noted, both lungs are clear and palpation of the abdomen, tender in the mid-epigastrium with guarding and rebound tenderness.

Study Questions:
1. How is the case of Mr. Lopez associated with pancreatitis?
2. What are the other possible differential diagnosis to be ordered for Mr. Lopez?

Answer 1

1.mr. lopez showing the typical features of acute pancreatitis.
Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen.the main symptoms includes

Upper abdominal pain
Abdominal pain that radiates to your back
Abdominal pain that feels worse after eating
Fever
Rapid pulse
Nausea
Vomiting
Tenderness when touching the abdomen.

Mr lopez showingsudden onsret abdominal pain after having meals, and pain radiating to back, severe vomiting, rebound tenderness in the abdomen. And also his vital signs showing elevated body temperature and heartrate it is typical sign of inflammation. So we can susoect that patient may have pancreatitis.

2.the differential diagnisis can be given for this case is following

•PUD
• GERD
• MI
• AAA- abdominal aortic aneurysm
• Gallbladder and common bile duct
obstruction.

These conditions also showing some ofthe above symptoms of patient. Some common symptoms are epigastric pain, vomiting or nausea, and rebound tenderness in the epigastrium.

These can be confirmed by diagnostic test such as

Ultrasound scan of abdomen

CT scan

MRI scan.