EPIGASTRIC PAIN portal上腹部疼痛门.lhup.pptxVIP

EPIGASTRIC PAIN ER CASE REPORT PATRICK J. NAGLE CASE REPORT A 79 y/o female Caucasian presented to the ED with a friend complaining of severe, sharp epigastric pain that radiated into her chest, back, and pelvic region. She has been having the pain for about 2 months, but it has progressively been getting worse since that time. Initially the pain was rated at a 2 or 3 out of 10, but within the past week has become a constant sharp pain rated between 8 and 10 out of 10. She now has a lot of difficulty eating because the pain is so severe. Pt thought she was constipated so she took some over-the-counter Colace thinking it would help. This was the only method of relief the pt attempted and it was unsuccessful. CASE REPORT, CONT… The pt denies having any fever, chills, night sweats, abnormal weight loss/gain, malaise, lymphadenopathy, difficulties or painful swallowing, N/V/D, blood in her mucus or stools, change in color or caliber of bowel movements, difficulties or changes in urination, wheezing, cough, SOB, SOB on exertion, chest tightness or pressure, palpitations, PND, orthopnea, fainting, dizziness, swelling of feet, or abnormal bleeding and bruising. PMH Pt is known to have allergies to iodine resulting in kidney failure. PMH revealed documentation of Type II DM, HTN, hypercholesterolemia, CHF, stroke, MI, CAD, CABG x 3 - 2 months ago, AAA repair - 2 years ago, complete left mastectomy 7 years ago, GERD, removal of her gallbladder and appendectomy – over 20 years ago. Both sides of the patient’s family has a history of DM, HTN, dyslipidemia, and breast cancer is known on her side of the family. She has not been exposed/used tobacco, alcohol, or illicit drugs. PHYSICAL EXAM Pt appears to be in moderate to severe discomfort with severe, sharp pain throughout the epigastric region of her stomach that radiated into the chest, back, and pelvic area. Abdominal aorta auscultated with no sounds indicating a possible leak. Normoactive bowel sounds with clicks and gurgl