Need Help with Case Study Plz.

[amynahmed]

Patient presents the following symptoms:

- pain in the right upper quadrant, epigastric area, and subscapular area.

-palpation reveals normal sized, but significant tenderness in right upper quadrant

-history of extreme indegestion following ingestion of fatty foods

-elevated temperature

-nausea and vomitting

-white count 12,500

a. what is your diagnosis?

b. what medical tests would you order to confirm this?

c. treatment?

d. additional blood work revealed elevated serum lipases and amylases. where would these come from? also, why did mr. frie's problem lead to these elevation? (you'll have to really dig into the anatomy to answer this one)

Thank you.

Amy

[TexasPediRN]

Many of us are hesitant to answer student questions completely. We dont want to do anyones work for them! However, if you let us know what you are thinking, we can steer you in the right direction if you are not already there.

So let us know what you think the answers are first, and then we'll help you out! First think about what organs are in the right upper quad that would present with pain in the epigastic area, and would go along with the other diagnoses you gave. Once you have figured out the organ, see what tests you would need to order.

Good Luck!

-Meghan

[SFCardiacRN]

It is hard to diagnose abdominal pain. Concentrate on the other symptoms and let us know where you are heading. Then I'll help. Nursing is about learning critical thinking and case studies are how you learn it.

[Daytonite, BSN, RN]

amy,

i've put together some links for you to explore. there are more links you can look at within the family practice notebook site. my first inclination is to say that this patient has gallstones. then, when you mention this is a man and here he is with subscapular pain i'm wondering about his heart too although that is a bit farfetched. but, if part "d" of the question is the real clincher to it all, then i think that your answer lies there, so i included links to lab tests online for you to check out. however, abdominal pain is such a broad and vague symptom that there needs to be a good deal of examination and tests done to determine what is really going on. big burning question in my mind (i worked med/surg for years) is i want to know if mr. frie is a drinker.

hope that helps you get started.

http://www.fpnotebook.com/sur65.htm - evaluation of abdominal pain

http://www.fpnotebook.com/sur74.htm - here is a list of the most common causes of ruq pain for you to check out.

http://www.labtestsonline.org/understanding/analytes/amylase/test.html - information on the test for amylase

http://www.labtestsonline.org/understanding/analytes/lipase/test.html - information on the test for lipase

[amynahmed]

Progressing to gallstones blocking pancreatic duct leading to pancreatitis.Am I on the right track?

[VickyRN, MSN, DNP, RN]

Progressing to gallstones blocking pancreatic duct leading to pancreatitis.Am I on the right track?

Yes, most definitely :)

https://www.bcbsri.com/BCBSRIWeb/images/mayo_popup/Pancreatitisandgallstones.jsp

http://www.endonurse.com/articles/2c1feat3.html

http://gulfmd.com/gastroenterology%20-%20alcohol/Gallstones.asp?id=13

http://www.fpnotebook.com/GI158.htm

[VickyRN, MSN, DNP, RN]

Another source of great information:

http://www.healthsci.clayton.edu/Nurs3320/NURS3320meta.htm