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Chronic and Recurring Severe Abdominal Pain Case Study

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Health & Medical
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Case Study
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CASE PRESENTATION
You are called in the early hours of the morning to a local residence in a lower income area
of town for a 47-year-old man who presents with severe abdominal pain that woke him
from his sleep. As you arrive on scene you notice the home is poorly maintained with a
moderate amount of “junk” around the property. You do not perceive any immediate
threats and you approach the front entrance where the door is open. You announce
yourself and your partner. The patient tells you to come in. As you enter you find the
patient, a thin, slightly emaciated man is sitting on the couch in obvious distress. He has
purposeful movements as you approach and ask his chief complaint. In a clear voice using
appropriate words he states he has intermittent abdominal pain for a week and was
awoken from his sleep about 15 minutes ago with intense abdominal pain. You note his
airway is clear, he is breathing rapidly and his pulse is fast and easily felt. Your partner
prepares the stretcher for transport while you continue to ask history questions and assess
vital signs. He describes the pain as an intermittent “gas-like” pain in the epigastric
region. He says he feels like he needs to “burp.” He continues to describe it as a band like
pattern around his upper abdomen and lower chest. It is most intense when he lies flat but
seems to have some relief when sitting upright smoking a cigarette. He took two tablets of
Naprosyn to reduce his typical aches and pains in his knees and ankles. He reports mild
nausea but has not vomited. His last bowel movement was yesterday and described as a
loose watery stool of normal color. He denies chest pain, palpitations nor shortness of
breath. He denies chronic medical conditions and does not take any medications, OTC,
prescription or herbal medications on a regular basis. He also denies recreational drug use

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but admits from 6-8 beers daily. He denies allergies.
On physical examination, his temperature is 35.4°C (95.7°F), blood pressure 111/62 mm
Hg, heart rate 97 beats per minute, and respiratory rate of 28 breaths per minute sating
98% on room air. He is diaphoretic, skin is normal in color and warm. He is unable to get
comfortable on the gurney and is writhing in pain. Mucus membranes are dry, eyes are
non-icteric with pupils that are round, equal and react to light. His lungs are equal, clear
to auscultation with good excursion bilaterally. No rales or rhonchi are found. The
abdomen is exquisitely tender on palpation to the epigastric region and both upper
quadrants with focal rebound tenderness and guarding. No tenderness or masses are felt
in the lower quadrants.
QUESTIONS
What other assessment or diagnostic information would you gather on this patient?
An assessment of this patient shall proceed with the following steps:
History of Present Illness (HOPI):
The history of present illness must bring out a correct narrative of the symptoms by the patient.
This includes:

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CASE PRESENTATION You are called in the early hours of the morning to a local residence in a lower income area of town for a 47-year-old man who presents with severe abdominal pain that woke him from his sleep. As you arrive on scene you notice the home is poorly maintained with a moderate amount of “junk” around the property. You do not perceive any immediate threats and you approach the front entrance where the door is open. You announce yourself and your partner. The patient tells you to come in. As you enter you find the patient, a thin, slightly emaciated man is sitting on the couch in obvious distress. He has purposeful movements as you approach and ask his chief complaint. In a clear voice using appropriate words he states he has intermittent abdominal pain for a week and was awoken from his sleep about 15 minutes ago with intense abdominal pain. You note his airway is clear, he is breathing rapidly and his pulse is fast and easily felt. Your partner prepares the stretcher for transport while you continue to ask history questions and assess vital signs. He describes the pain as an intermittent “gas-like” pain in the epigastric region. He says he feels like he needs to “burp.” He continues to describe it as a band like pattern around his upper abdomen and lower chest. It is most intense when he lies flat but seems to have some relief when sitting upright smoking a cigarette. He took two tablets of Naprosyn to reduce his typical aches and pains in his knees ...
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