Assessing the Abdomen Gastroenteritis Sample Paper
A 47-year-old white male patient presents with generalized abdominal pain for three days. He has not taken any medication and rates the pain as a 5 out of 10. He however, notes that the pain was a 9 out of 10 during the initial stages. He has been able to eat but complains of nausea afterwards. Patient is a known diabetic who is also hypertensive. He has a history of gastrointestinal bleeding four years ago.
He is currently on Lisinopril, Amlodipine, Metformin and Lantus. The patient’s father is hypertensive and has type 2 diabetes mellitus. The mother is hypertensive, has hyperlipidaemia and gastroesophageal reflux disease. Patient denies any use of tobacco but is an occasional consumer of alcohol. He is married and has three children. His vitals are within the normal range apart from the blood pressure which is slightly elevated and the temperature which indicates a fever. The assessment shows left lower quadrant pain and the diagnosis made is gastroenteritis.
Necessary History
Subjective portion
It is necessary for the patient to characterize the onset of the pain. He should describe whether it had a sudden onset or whether it started gradually. The patient should also describe the character of the pain. It is important to know whether it is a stabbing pain, a burning pain or an intermittent pain (Bennett et. al, 2019). The patient should also describe if the pain was radiating to any other part of the body or if it was non-radiating. The patient should describe any other associated symptoms that accompanied the pain.
Further, it is crucial to know the timing of the pain. Is it worse at night, during the morning hours or during daytime? It is crucial to also find out what exacerbated the pain and what made it more bearable or relieved it. It is also critical to get a clear picture of the patient’s stool. Is it accompanied with any fresh blood or clots? It is also good to know if there is any mucus in the stool. It is also crucial to rule out other accompanying symptoms such as fever.
Objective portion
It is important to calculate the patient’s Body Mass Index (BMI). It is critical to describe any masses present on abdominal examination. Movement of the abdomen with respiration is also important to note. Lack of abdominal movement with irritation would highlight an irritation on the peritoneum indicating the presence of an infection. Presence of any distended veins on the abdomen would also be critical to highlight. The presence of any flank fullness indicating the presence of fluid would also be important to highlight.
The clinical assessment of gastroenteritis is supported by both the objective and the subjective information. The patient complaining of generalized abdominal pain and the presence of diarrhoea is a key feature of gastroenteritis. The elevated temperature of 99.8F indicates a fever which is also a symptom of gastroenteritis (Doggweiler et al., 2017). The hyperactive bowel movement sounds heard on auscultation are also a key presentation feature of gastroenteritis. Notably, the features that include diarrhoea, generalized abdominal pain which is localized in the left lower quadrant, fever and the hyperactive bowel sounds all support the diagnosis of gastroenteritis.
Diagnostic tests
Stool test is effective to determine the cause of the gastroenteritis. A rapid stool test can aid in the detection of viruses such as rotavirus and norovirus which are among the commonest causes of gastroenteritis (Karampatsas et al., 2018). A stool sample can also help in ruling out the possibility of a bacterial or a parasitic infection. Presence of viruses such as the rotavirus can help in coming up with a conclusive diagnosis of gastroenteritis. Additionally, a complete blood count is also key in making a diagnosis. Elevated white blood cells indicate the presence of infection. Further white blood cell differential tests will help to determine the exact cause of the gastroenteritis. Elevated neutrophils will indicate that the most likely cause of the gastroenteritis is a bacterial infection while lymphocyte levels will be increased during viral infections.
Ultrasound scans, CT scans or X-rays may also be used to make a diagnosis. However, these tests are rarely done as the diagnosis of gastroenteritis is often made from the history. This imaging techniques may be critical in showing an inflammation of the stomach wall. This evidence, coupled with the diagnostic tests, will help in further justifying the clinical diagnosis made of gastroenteritis. I would accept the current diagnosis of gastroenteritis since the presenting symptoms of diarrhoea and localised abdominal pain are some of the symptoms of gastroenteritis. On examination, the fever, localised left lower quadrant pain and the hyperactive bowel sounds all support the diagnosis. Accompanying laboratory diagnostic tests would further support the diagnosis of gastroenteritis and give the probable cause of the gastroenteritis.
Differential Diagnosis
The three possible conditions identified as the differential diagnosis for the patient include:
Amoebiasis is a parasitic infection of the large intestines caused by Entamoeba histolytica (Ghosh, Padalia, & Moonah, 2019). Amoebiasis normally presents with generalized abdominal pain, bloody diarrhoea and fever which may be confused with gastroenteritis. In most people, amoebiasis is asymptomatic but a few individuals develop the symptoms stated above among others. A travel history, especially to regions with poor sanitation and water, is key in establishing a diagnosis of amoebiasis.
- Salmonella infections.
Salmonella infection is another differential diagnosis. This infection is caused by the salmonella bacteria commonly harboured in contaminated food and water (Gut et al., 2017). Some of the key symptoms of salmonella infection include diarrhoea accompanied with fever and chills. Abdominal pain is another presenting complaint. Some people hardly develop any symptoms. Those who develop symptoms usually develop them between six hours and six days of infection. The symptoms normally last between four to seven days.
- Food poisoning.
Food poisoning is another differential diagnosis. Abdominal pain, fever, diarrhoea, and nausea among others are some of the major symptoms of food poisoning (Mostafa et al., 2018). Food poisoning commonly results from ingestion of contaminated food containing viruses, bacteria, parasites and fungi or their resultant toxins. Signs and symptoms are normally visible after a few hours of ingestion of the contaminated food. Illness lasts from a few hours to a few days.
Conclusion
Due to increased cases of misdiagnosis, it is critical to get both subjective, objective and diagnostic data to confirm diagnosis. Misdiagnosis reduces the chance of the patient getting well as the medication being administered is not effective. This increases the patient’s stay in hospital and consequently increases the likelihood of development of drug resistant pathogens. It is therefore critical to make and confirm the diagnosis before initiating management and treatment. In the case scenario, diarrhoea, abdominal pain, nausea and fever all aid in the establishment of the diagnosis of gastroenteritis. Laboratory diagnostic tests can be done to further support the diagnosis.
References
- Bennett, M. I., Kaasa, S., Barke, A., Korwisi, B., Rief, W., & Treede, R. D. (2019). The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain, 160(1), 38-44. https://doi.org/10.1097/j.pain.0000000000001363
- Ghosh, S., Padalia, J., & Moonah, S. (2019). Tissue destruction caused by Entamoeba histolytica parasite: cell death, inflammation, invasion, and the gut microbiome. Current Clinical Microbiology Reports, 6(1), 51-57. https://doi.org/10.1007/s40588-019-0113-6
- Gut, A. M., Vasiljevic, T., Yeager, T., & Donkor, O. N. (2018). Salmonella infection–prevention and treatment by antibiotics and probiotic yeasts: a review. Microbiology, 164(11), 1327-1344. https://doi.org/10.1099/mic.0.000709
- Karampatsas, K., Osborne, L., Seah, M. L., Tong, C. Y., & Prendergast, A. J. (2018). Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PloS One, 13(3), e0194009. https://doi.org/10.1371/journal.pone.0194009
- Mostafa, A. A., Al-Askar, A. A., Almaary, K. S., Dawoud, T. M., Sholkamy, E. N., & Bakri, M. M. (2018). Antimicrobial activity of some plant extracts against bacterial strains causing food poisoning diseases. Saudi Journal of Biological Sciences, 25(2), 361-366. https://doi.org/10.1016/j.sjbs.2017.02.004