Posted: February 28th, 2022

Mrs. Deer is a 72-year-old female who presents to your office

D3
Case 3
Mrs. Deer is a 72-year-old female who presents to your office complaining of right upper quadrant pain that has been increasing in intensity over the past 2 days. She would have come sooner, but she lacked transportation and waited until her son could drive her. She states that she has not been sleeping very much because of the pain. She has been nauseous and vomited a couple of times two days ago but has only been drinking fluids. She states that she has not been around anyone else that had an upset stomach. She recalls prior to the onset of pain she had been at a church supper that included meats, refried beans, and many desserts which she sampled. She described the fried pies that she brought to the supper and ate the extras that afternoon.
Vital Signs: BP 130/80, HR 85, RR 20, Temp 99.0°F.
Discuss the following:
1) What additional subjective data are you seeking to include past medical history, social, and relevant family history?
2) What additional objective data will you be assessing for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What radiological examinations or additional diagnostic studies would you order?
6) What treatment and specific information about the prescription that you will give this patient?
7) What are the potential complications from the treatment ordered?
8) What additional laboratory tests might you consider ordering?
9) What additional patient teaching may be needed?
10) Will you be looking for a consult?

Submission Instructions:
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• Please post your initial response by 11:59 PM ET Thursday
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Grading Rubric
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Your assignment will be graded according to the grading rubric.
Discussion Rubric
Criteria Ratings Points
Identification of Main Issues, Problems, and Concepts Distinguished – 5 points
Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts. Excellent – 4 points
Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts. Fair – 2 points
Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts. Poor – 1 point
Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts. 5 points
Use of Citations, Writing Mechanics and APA Formatting Guidelines Distinguished – 3 points
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors. Excellent – 2 points
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors. Fair – 1 point
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail. Poor – 0 points
Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. 3 points

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What additional subjective data are you seeking to include past medical history, social, and relevant family history?
To gather a comprehensive medical history, it is important to ask Mrs. Deer additional subjective questions related to her past medical history, social factors, and relevant family history. The following information would be helpful:

a) Past Medical History:

Inquire about any pre-existing medical conditions such as diabetes, hypertension, liver disease, gallbladder disease, or any other relevant conditions.
Ask about any previous abdominal surgeries, particularly involving the gallbladder or gastrointestinal tract.
Determine if she has a history of similar episodes of right upper quadrant pain in the past.
b) Social History:

Explore Mrs. Deer’s occupation, as certain jobs may involve exposure to toxins or substances that can affect the liver or gastrointestinal system.
Assess her alcohol consumption patterns, as excessive alcohol intake can contribute to liver disease or gallbladder dysfunction.
Inquire about any recent travel history, particularly to areas with a higher prevalence of certain infections or foodborne illnesses.
Discuss her dietary habits and any recent changes, including the consumption of high-fat or greasy foods.
c) Family History:

Ask about a family history of gallbladder disease, liver disease, or gastrointestinal conditions.
Inquire about any genetic conditions that may be relevant to her symptoms, such as familial cholelithiasis.
What additional objective data will you be assessing for?
To further evaluate Mrs. Deer’s condition, the following objective data should be assessed:

a) Abdominal Examination:

Perform a thorough abdominal examination, paying particular attention to the right upper quadrant. Palpate for tenderness, hepatomegaly, or any masses.
Assess for signs of jaundice, such as yellowing of the skin or sclerae.
Check for any signs of peritoneal irritation, such as guarding or rebound tenderness.
b) Laboratory Investigations:

Complete blood count (CBC) to assess for signs of infection or inflammation.
Liver function tests (LFTs) to evaluate liver enzymes, bilirubin levels, and synthetic function.
Amylase and lipase levels to rule out pancreatitis.
Serum electrolytes and renal function tests to assess overall organ function.
Coagulation profile to assess clotting factors and rule out any coagulopathies.
What are the differential diagnoses that you are considering?
Based on the provided information, the possible differential diagnoses to consider include:

Acute cholecystitis
Choledocholithiasis (common bile duct stone)
Acute pancreatitis
Gastroenteritis
Hepatitis
Gastric or duodenal ulcer
Gastrointestinal malignancy
What laboratory tests will help you rule out some of the differential diagnoses?
To help rule out some of the differential diagnoses, the following laboratory tests would be helpful:

Abdominal ultrasound: This can assess the gallbladder for the presence of gallstones, gallbladder wall thickening, or signs of cholecystitis.
Hepatitis serology: To determine if there is an active viral infection contributing to the symptoms.
Stool studies: To assess for infectious causes of gastroenteritis.
Lipase levels: Elevated levels would support the diagnosis of acute pancreatitis.
Complete metabolic panel: To assess liver function, renal function, and electrolyte levels.
Tumor markers (e.g., CEA, CA 19-9): If there is suspicion of gastrointestinal malignancy.
What radiological examinations or additional diagnostic studies would you order?
In addition to the laboratory tests mentioned above, the following radiological examinations and diagnostic studies may be ordered:

Abdominal CT

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