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KAREN FLOYD ABDOMINAL PAIN LATEST 2024 100%
GRADED
Questions –yields 90% How can I help you? My stomach hurts Do you have any other symptoms or concerns we should discuss? I occasionally feel “bloated” although I’m not sure my belly is actually bigger when I feel that way. I… well pass a lot of gas and… even belch a lot compared to other people I know. Sort of embarrassing for a woman you know. Do you think that’s related to all of this? Is your pain affected by what, when, or how much you eat? It seems to be worse with rich foods. I haven’t really noticed it as associated with when or how much. Do you now or have you ever smoked or chewed tobacco? No, I never have. Are you taking any over the counter or herbal medications? I take a multivitamin daily, and acetaminophen from time to time for stress headaches Are you taking any prescription medications? No prescription medications Do you have any allergies? Not that I know of Have you ever been hospitalized? Just for the c-section and the bike accident thing Any previous medical, surgical, or dental procedures? I had a c-section at 27 without any complications. When I was 17, I had a bike accident and had a complicated fracture of my right tibia. They had to fix that with surgery. Can you tell me about any current or past medical problems you have had? I don’t know really what’s important. The only thing besides this stomach problem is that lately I’ve been getting occasional hot flashes and my skin is sort of dry. I also get headaches now and then which isn’t new and that probably isn’t important anyway. Is that the kind of things you want to know?
Do you have diarrhea? Occasionally. Sometimes I’d say my bowel movement is loose and watery. Does that count? Is there any blood in your stools or with your bowel movement? Anything red? Not that I have noticed Do you have a problem with constipation? Definitely. For as long as I can recall in my adult life, I have alternating periods of constipation and just the opposite if you know what I mean that lasts several days. When I am constipated, I feel like I cannot get everything out, even after a BM. Have you been having fevers? I don’t think so, can you check that for me How often does this abdominal pain occur? It’s been coming and going for years now. It never really goes away entirely, but then it also doesn’t seem to be getting a lot worse. It’s just there all the time. So frustrating.
the EHR
Tell me about your work I am a manager at a local restaurant. I have very long workdays… I usually work late into the night. Have you had a recent endoscopy, colonoscopy, or biopsy? Uh… No. When and what was the result of your last mammogram? I haven’t had one yet. Too busy. Physical Exam Blood pressure 120/60, normal, normotensive Cognitive Alert and oriented x 4 Pulse 60, regular, normal RR 14, regular, unlabored Temp 98. Inspect skin overall Dry skin, otherwise unremarkable
Rectal exam Normal Genitourinary female exam Normal external genitalia, no masses or tenderness, normal pelvic exam. Deep tendon reflexes Triceps 2/ Biceps 2/ Brachioradialis 2/ Knee/Patella 2/ Ankle/Achilles 2/ Assess pharynx movement and phonation Soft palate moves up symmetrically, speech phonation and articulation appropriate. Hearing No hearing deficits, normal Weber and Rinne tests. Monofilament test Normal sensory test Assess gait and stance Normal gait and posture Babinski Normal
Assess head rotation against resistance/shoulder elevation Symmetric muscle movement without weakness bilaterally Assess for muscle bulk and tone Normal bulk and tone, no rigidity. Look for involuntary movements None of the following movements:
- Fibrillations
- Fasciculations
- Asterixis
- Tics, myoclonus
- Dystonia’s
- Chorea
- Athetosis
- Hemiballismus
- Nor seizures Test strength Strength 5/5 bilaterally Visual inspection AP chest Chest is symmetrical and the AP diameter is normal. The excursion with respiration is symmetrical and there are no abnormal retractions or use of accessory muscles. No distension, scars, masses, or rashes. Palpate AP chest No tenderness, masses, heaves, thrills, or crepitus Percuss AP chest The anterior lung fields are resonant. The left anterior chest and right lower chest are dull to percussion. The rest of the lung fields are resonant and are not hyper-resonant. MSA P Stomach pain Stabbing/cramping abdominal pain Feels bloated Flatulence worse with rich foods Stress headache C-Section Bike riding accident, right tibia fracture Hot flashes Dry skin Occasional diarrhea Incomplete bowel movements Constipation Pain improved with bowel movements
4 Dyspepsia, functional X 5 GERD X 6 Peptic ulcer disease X 7 Cholelithiasis X 8 Colon cancer X X 9 Biliary colic X 10 Irritable bowel syndrome X 11 Crohn’s Disease X 12 Colitis, ulcerative X 13 Diverticulitis X 14 Large bowel obstruction X X 15 Hemorrhoids X 16 Colon neoplasm X 17 Small bowel obstruction X 18 Small bowel neoplasm X 19 Hypothyroidism X 20 Hyperthyroidism X 21 Diabetic neuropathy X 22 Generalized anxiety disorder X 23 Major depressive disorder X 24 Giardiasis X 25 Salmonellosis X 26 Shigellosis X 27 C. Diff X 28 E. Coli X 29 Campylobacteriosis X 30 Pelvic inflammatory disease X 31 Endometriosis X 32 Ovarian neoplasm X 33 Appendicitis X X 34 Microscopic colitis X 35 Colitis, infectious X 36 Lymphoma, non-Hodgkin’s X 37 Stomach cancer X 38 Adrenal insufficiency, primary X
39 DMT1 X
40 DMT2 X
41 Diarrhea, medication associated X 42 Constipation X 43 Tropical sprue X 44 Gastroenteritis X 45 Perforated viscus X 46 Pancreatitis, chronic X 47 Colitis, ischemic X 48 HIV X 49 Somatic symptom disorder X 50 Pancreatic insufficiency X
Splenic abscess X 8 3 Hepatitis, viral X 8 4 Follicular cyst X 8 5 Ascending cholangitis X 8 6 Hepatic venous outflow obstruction
X
Diagnostic Tests – 100% 1 Tissue glutaminase antibody (IgA-tTG) Negati ve
C Reactive Protein Norm al 3 Capsule endoscopy Norm al 4 Colon biopsy Norm al 5 Colonoscopy Norm al 6 Complete blood count Norm al 7 CMP Norm al 8 CT abdomen Norm al 9 CTA, abdomen Norm al 10 ESR Norm al 11 Sigmoidoscopy Norm al 12 Vitamin B12 Norm
Irritable bowel syndrome Exercises – yields 94%, but not graded per rubric Hematochezia Mucous in the stool Chronic, pellet, period, pain, urgency, sensation, acute Stress and eating Blood, significant, anorexia, pain False All of the above CBC, CRP, celiac sprue panel Management Plan https://journals.lww.com/ajg/fulltext/2021/01000/acg_clinical_guideline management_of_irritable.11.aspx https://www.gastrojournal.org/article/S0016- 5085(22)00390-0/fulltext https://pubmed.ncbi.nlm.nih.gov/33315591/ Chang, L., Sultan, S., Lembo, A., Verne, G., Smalley, W., Heidelbaugh, J. (2022). AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation. Gastroenterology, 163(1), 118-136. https://doi.org/10.1053/j.gastro.2022.04.
