ABDOMINAL ASSESSMENTSubjective:CC: "My stomach has been hurting for the past two days."HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain. PMH: HTNMedications: Metoprolol 50mgAllergies: NKDAFH: HTN, Gerd, HyperlipidemiaSocial Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female Objective:VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbsHeart: RRR, no murmursLungs: CTA, chest wall symmetricalSkin: Intact without lesions, no urticariaAbd: abdomen is tender in the epigastric area with guarding but without mass or rebound.Diagnostics: US and CTA Assessment:Abdominal Aortic Aneurysm (AAA)Perforated Ulcer PancreatitisThe AssignmentAnalyze the subjective portion of the note. List additional information that should be included in the documentation.Analyze the objective portion of the note. List additional information that should be included in the documentation.Is the assessment supported by the subjective and objective information? Why or why not?What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Alexander H. Stephens (1812-1883): Cornerstone Address, March 21, 18611Alexander H. Stephens was the vice president of the Confederacy. He delivered this speech in Savanna, Georgia less than a month before the Confederate attack on Ft. Sumter on April 12, 1861.... we are passing through one of the greatest revolutions in the annals of the world- seven States have, within the last three months, thrown off an old Government and formed a new. This revolution has been signally marked, up to this time, by the fact of its having been accomplished without the loss of a single drop of blood. [Applause.] This new Constitution, or form of government, constitutes the subject to which your attention will be partly invited.In reference to it, I make this first general remark: It amply secures all our ancient rights, franchises, and privileges. All the great principles of Magna Carta are retained in it. No citizen is deprived of life, liberty, or property, but by the judgment of his peers, under the laws of the land. The great principle of religious liberty, which was the honor and pride of the old Constitution, is still maintained and secured. All the essentials of the old Constitution, which have endeared it to the hearts of the American people, have been preserved and perpetuated.... So, taking the whole new Constitution, I have no hesitancy in giving it as my judgment, that it is decidedly better than the old. [Applause.] Allow me briefly to allude to some of these improvements. The question of building up class interests, or fostering one branch of industry to the prejudice of another, under the exercise of the revenue power, which gave us so much trouble under the old Constitution, is put at rest forever under the new. We allow the imposition of no duty with a view of giving advantage to one class of persons, in any trade or business, over those of another. All, under our system, stand upon the same broad principles of perfect equality. Honest labor and enterprise are left free and unrestricted in whatever pursuit they may be engaged in ....But not to be tedious in enumerating the numerous changes for the better, allow me to allude to one other-though last, not least: the new Constitution has put at rest forever all the agitating questions relating to our peculiar institutions-African slavery as it exists among us-the proper status of the negro in our form of civilization. This was the immediate cause of the late rupture and present revolution. Jefferson, in his forecast, had anticipated this, as the "rock upon which the old Union would split." He was right. What was conjecture with him, is now a realized fact. But whether he fully comprehended the great truth upon which that rock stood and stands, may be doubted.1 Excerpt from Fordham University’s Internet History Sourcebookhttp://www.fordham.edu/halsall/mod/1861stephens.html, retrieved on May 12, 2011. Full text available athttp://www.TeachingAmericanHistory.org/library/index.asp?documentprint=76,undefinedundefinedThe prevailing ideas entertained by him and most of the leading statesmen at the time of the formation of the old Constitution were, that the enslavement of the African was in violation of the laws of nature; that it was wrong in principle, socially, morally and politically. It was an evil they knew not well how to deal with; but the general opinion of the men of that day was, that, somehow or other, in the order of Providence, the institution would be evanescent and pass away. This idea, though not incorporated in the Constitution, was the prevailing idea at the time. The Constitution, it is true, secured every essential guarantee to the institution while it should last, and hence no argument can be justly used against the constitutional guarantees thus secured, because of the common sentiment of the day. Those ideas, however, were fundamentally wrong. They rested upon the assumption of the equality of races. This was an error. It was a sandy foundation, and the idea of a Government built upon it-when the "storm came and the wind blew, it fell."Our new Government is founded upon exactly the opposite ideas; its foundations are laid, its cornerstone rests, upon the great truth that the negro is not equal to the white man; that slavery, subordination to the superior race, is his natural and moral condition. [Applause.] This, our new Government, is the first, in the history of the world, based upon this great physical, philosophical, and moral truth. This truth has been slow in the process of its development, like all other truths in the various departments of science. It is so even amongst us. Many who hear me, perhaps, can recollect well that this truth was not generally admitted, even within their day. The errors of the past generation still clung to many as late as twenty years ago. Those at the North who still cling to these errors with a zeal above knowledge, we justly denominate fanatics. All fanaticism springs from an aberration of the mind; from a defect in reasoning. It is a species of insanity. One of the most striking characteristics of insanity, in many instances, is, forming correct conclusions from fancied or erroneous premises; so with the anti-slavery fanatics: their conclusions are right if their premises are. They assume that the negro is equal, and hence conclude that he is entitled to equal privileges and rights, with the white man.... I recollect once of having heard a gentleman from one of the Northern States, of great power and ability, announce in the House of Representatives, with imposing effect, that we of the South would be compelled, ultimately, to yield upon this subject of slavery; that it was as impossible to war successfully against a principle in politics, as it was in physics or mechanics. That the principle would ultimately prevail. That we, in maintaining slavery as it exists with us, were warring against a principle-a principle founded in nature, the principle of the equality of man. The reply I made to him was, that upon his own grounds we should succeed, and that he and his associates in their crusade against our institutions would ultimately fail. The truth announced, that it was as impossible to war successfully against a principle in politics as well as in physics and mechanics, I admitted, but told him it was he and those acting with him who were warring against a principle. They were attempting to make things equal which the Creator had made unequal.In the conflict thus far, success has been on our side, complete throughout the length and breadth of the Confederate States. It is upon this, as I have stated, our social fabric is firmly planted; and I cannot permit myself to doubt the ultimate success of a full recognition of this principle throughout the civilized and enlightened world.As I have stated, the truth of this principle may be slow in development, as all truths are, and ever have been, in the various branches of science. It was so with the principles announced by Galileo-it was so with Adam Smith and his principles of political economy. It was so with Harvey, and his theory of the circulation of the blood. It is stated that not a single one of the medical profession, living at the time of the announcement of the truths made by him, admitted them. Now, they are universally acknowledged. May we not therefore look with confidence to the ultimate universal acknowledgment of the truths upon which our system rests? It is the first Government ever instituted upon principles in strict conformity to nature, and the ordination of Providence, in furnishing the materials of human society. Many Governments have been founded upon the principles of certain classes; but the classes thus enslaved, were of the same race, and in violation of the laws of nature. Our system commits no such violation of nature's laws. The negro by nature, or by the curse against Canaan, [note: A reference to Genesis, 9:20-27, which was used as a justification for slavery] is fitted for that condition which he occupies in our system. The architect, in the construction of buildings, lays the foundation with the proper material-the granite-then comes the brick or the marble. The substratum of our society is made of the material fitted by nature for it, and by experience we know that it is the best, not only for the superior but for the inferior race, that it should be so. It is, indeed, in conformity with the Creator. It is not for us to inquire into the wisdom of His ordinances or to question them. For His own purposes He has made one race to differ from another, as He has made "one star to differ from another in glory."The great objects of humanity are best attained, when conformed to his laws and degrees [sic], in the formation of Governments as well as in all things else. Our Confederacy is founded upon principles in strict conformity with these laws. This stone which was rejected by the first builders "is become the chief stone of the corner" in our new edifice.