Abdominal Case Studies

DIAGNOSTIC DATA: White count was 13.4, hemoglobin and hematocrit 15.4 and 45.8, platelets 206, with an 89% shift. Sodium 133, potassium 3.7, chloride 99, bicarb 24, BUN and creatinine are 18 and 1.1, respectively. Glucose 146, albumin 4.3, total bilirubin 1.7. The remainder of the LFTs is within normal limits. Urinalysis reveals trace ketones with 100mg per decilitre protein and a small amount of blood. CT scan was performed revealing evidence of acute appendicitis with pericecal inflammation, as well as, dilatation of the appendix and

Breasts: no masses, no nipple retraction, no discharge. Heart: S1 and S2, no gallops, rubs, or murmurs appreciated. Abdomen is scaphoid, soft and non-tender with positive bubble sounds. Pelvic/ Rectal: deferred as patient has recently visited her GYN for a routine Pap smear. Neurologic exam reveals normal motor strength in all muscle

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

There was perhaps just a little bit of erythema, particularly at the six o'clock position. No vaginal mucosal lesions were noted. The cervix appeared normal. There was a thinner yellowish discharge in the vault, that had a somewhat fishy odor.

PHYSICAL EXAMINATION: Vital signs are WNL. Apparently he has had no chills, night sweats, or favors. Generalized malaise and a lack of energy have been the main concerns. HEART: Regular rate and rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS: Bilateral rhonchi. No significant amphoric sounds are noted. ABDOMON: Soft nontender. No hepatosplenomegaly or masses are detected. RECTAL EXAM: Prostate smooth and firm. No stool is present for hemoccult test.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

A 25-year-old female presents to your clinic for evaluation of a mass in the vulvar area. This has been present for the last 1 week and tender to touch, there is no fever and no chills. Upon exam, you noticed that there is a medially protruding mass in the introitus area around a radius of 1.5 cm and tender to touch with some induration around the area. You advised the patient that the most likely diagnoses in this case are:

The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body systems, which included all required elements. Medical decision making was of moderate complexity.

On physical exam, weight is 49 pounds. She is alert and in no acute distress. Her abdomen is soft. She does complain of some tenderness, but there is no guarding and there is no organomegaly or masses. Genitalia feels normal, (___) female.

The patient is a 78-year-old gentleman who presents to the ED complaining of painful urination and severe swelling and erythema of the scrotal area. This has been going on for several days. He was seen approximately 2 weeks ago in the urologists office. He was placed on antibiotics but he continued to have increasing pain, increasing swelling and frequency of urination. He is known to have a history of hypertension, some the dementia, diabetes and history of CVA in the past. On presentation his BP is 123/60, pulse of 73, respirations of 16, he is afebrile and is oxygenating well on room air. He is completely cultured in the ED. Ultrasound of the scrotum and testes is done. He has scrotal wall cellulitis, right testicular cyst, bilaterally

Hello Thelma, you brought up great information on how to assess the abdomen thoroughly. I absolutely agree with you, the abdomen should be assessed in a systematic approach. I would inspect, auscultate, percuss, and palpate the abdomen. I would definitely listen to dull sound when percussing the abdomen which is common sound with someone who has ascites. As mentioned by Jarvis (2012), dullness occurs over fluid or mass area. I would approach palpation in a careful manner to especially to the enlarged and tender area of the abdomen. M.M is exhibiting fatigue, weight loss, and anorexia which are due to his long term use of alcohol from the past. I would also try to get labs and diagnostic testing to rule out cirrhosis and plan for accurate treatment.

When groups of internal scar tissue band together, the result is an abdominal adhesion. While most people believe that internal scar tissue is formed after surgery, there is no hard-and-fast rule for the formation of the initial scar tissue itself. Scar tissue is what develops when the body is trying to heal itself after infections, bleeding, bodily injuries, inflammatory diseases, chronic intestinal conditions, physical trauma, and radiation treatments, as well as after surgical procedures.

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.