week 5 posting
This week, complete the case study titled “Jerome Cauthen” write a 2-3 pages to answer the following questions using only peer -reviewed articles or evidence -based websites, NO patient or customer websites as reference. APA format.
Using the Case Study provided answer the following questions:
* What is your list of appropriate differential diagnoses and why?
* What is the final diagnosis and what assessment findings serve to support this? ( acute appendicitis is what I decided for final diagnosis )What are the specific auscultation palpation findings of the abdomen that are normal versus abnormal?
CASE STUDY information ;
Mr. Cauthen, a 22-year-old male, presents following the acute onset of diffuse midabdominal pain. He denies a history of gastrointestinal disease, hepatic or renal disease, previous abdominal surgery, or recent trauma. He does not use NSAIDs, aspirin, alcohol, or tobacco products.
Problem
Acute onset diffuse abdominal pain.
Most Significant Active Problem
*Rebound tenderness and guarding
*Anorexia
Expert: Problem List Feedback
The problem list allows you to begin to see the overall, or unified, constellation of significant signs and symptoms. It is also the starting point for developing, and then ranking, your diagnostic hypotheses. The pertinent presence or absence of other critical signs and symptoms will aid your assessment of the severity of the presenting complaint and your assessment of potential comorbidities.
Mr. Cauthen’s problem list is brief and seemingly focused. Nonetheless, his symptoms are fairly nonspecific; his vital signs are normal; and, there are no other physical exam findings to help guide your differential diagnosis.
However, given that rebound tenderness suggests aggravation of the inflamed parietal peritoneum, you do have an important starting point. Your differential diagnosis should be broad enough to capture several processes that can present with signs of peritoneal inflammation in an otherwise healthy young male.
Cartwright SL, Knudson, MP. Evaluation of Acute Abdominal Pain in Adults, American Family Physician. 2008;77(7):971-978.
Ebell MH. Diagnosis of Appendicitis: Part I. History and Physical Examination, American Family Physician. 2008;77(6):828-830.
Ebell MH. Diagnosis of Appendicitis: Part II. Laboratory and Imaging Tests, American Family Physician. 2008;77(8):1153-1155.
Expert Solution Preview
Introduction:
The case study of Mr. Cauthen presents a perplexing problem of acute onset diffuse abdominal pain without any significant history of gastrointestinal, hepatic or renal disease or recent trauma. The patient complains of symptoms such as rebound tenderness and guarding, and anorexia. This post will answer the following questions:
* What is your list of appropriate differential diagnoses and why?
* What is the final diagnosis, and what assessment findings serve to support this? (Acute appendicitis is what I decided for the final diagnosis). What are the specific auscultation palpation findings of the abdomen that are normal versus abnormal?
Answer:
The list of appropriate differential diagnoses for Mr. Cauthen includes quite a few possibilities. However, for this particular case study, the differential diagnoses may include acute appendicitis, pancreatitis, gastrointestinal perforation, inflammatory bowel disease, gastroenteritis, irritable bowel syndrome, renal colic, diverticulitis, or cholecystitis.
Looking at the patient’s age and symptoms, the final diagnosis would most likely be acute appendicitis. Mr. Cauthen’s symptoms of rebound tenderness and guarding support this diagnosis. According to the evidence-based website American Family Physician, the presence of such symptoms suggests aggravation of the inflamed parietal peritoneum. Moreover, the lack of specific physical examination findings, normal vital signs, and the absence of significant gastrointestinal, hepatic, or renal disease, further increases the probability of an acute appendicitis diagnosis.
On auscultation and palpation, the abdominal area should feel soft, non-tender, and non-distended. Any pain felt on palpation, especially if rebound or guarding is present, would suggest a more serious pathology. Therefore, increased or decreased bowel sounds, along with distended, tender, or hard abdomen, would be considered abnormal findings.
In conclusion, the case study of Mr. Cauthen presents a challenging diagnosis scenario. However, assessing the presenting problem and examining the symptoms and signs, as well as viewing the evidence-based websites can help to narrow down and identify the appropriate diagnosis.
