A patient came to the emergency room with complaints of generalized abdominal pain and diarrhea. The pain started three days ago and initially was 9/10 in intensity but then decreased to 5/10. The patient has not taken any medications; he was able to eat with some nausea afterwards. The subjective and objective assessments were performed, and possible diagnoses were identified. In order to provide treatment, relevant tests need to be performed, and a differential diagnosis needs to be made with regard to the symptoms.
The subjective information about the patient’s condition includes general information about the symptoms, the patient’s present health status and past medical history, family history, known allergies, and current lifestyle. To collect a more comprehensive picture, the subjective assessment should include questions concerning the possible causes of abdominal pain and the nature of pain (Baid et al., 2016). Questions about causes should include inquiries regarding the patient’s diet, weight gain or loss, recent changes in lifestyle, travels, and other risk factors that the patient might have been subjected to. The questions about the pain should aim to establish the nature of pain, aggravating and relieving factors, its exact location, and radiation.
The objective information includes the patient’s vital signs and the results of the heart, lungs, skin, and abdomen examination. When performing a physical exam, the focus should be on the gastrointestinal assessment. It includes inspection, auscultation, percussion, and light palpation of the abdomen to identify visible abnormalities, bowel sounds, and softness (Baid et al., 2016). The performed examination reports a soft abdomen, hyperactive bowel sounds, and pain in the lower left quadrant. Additional information should include the results of the iliopsoas muscle test, obturator test, and Blumberg Sign, which are generally performed on patients with acute abdominal pain.
The assessment identifies two possible diagnoses: left lower quadrant pain and gastroenteritis. Gastroenteritis is a short-term illness triggered by the infection and inflammation of the digestive system, with symptoms including abdominal cramps, diarrhea, and vomiting (Gastroenteritis, n.d.). As for left abdominal pain, according to Saliba et al. (2019), “multiple differential diagnoses can be cited, including acute diverticulitis, a long right-sided acute appendicitis, and a left-side acute appendicitis.” For left abdominal pain accompanied by diarrhea, diverticulitis is one of the most common causes (Saliba et al., 2019). Its symptoms include fever, nausea, vomiting, and abdominal tenderness. In the present case, diverticulitis can be included in the differential diagnosis based on the results of the subjective and objective assessment.
Apart from gastroenteritis and diverticulitis, other possible conditions that can be considered as a differential diagnosis for the patient include irritable bowel syndrome, pseudomembranous colitis, and trapped inguinal. Irritable bowel syndrome’s symptoms include diarrhea and crampy or sharp abdominal pain (Dong & Zeng, 2019). Pseudomembranous colitis is characterized by abdominal pain, diarrhea, nausea, vomiting, and fever (Dong & Zeng, 2019). Trapped inguinal causes pain in the abdomen, usually on one side, and vomiting (Payne, 2017). To identify the cause of pain, several tests need to be conducted.
The diagnostic tests that should be performed in this case include computed tomography, blood tests, and colonoscopy. Computed tomography is the preferred test in evaluating clinically suspected diverticulitis that also helps to diagnose other causes of left lower quadrant pain. Colonoscopy is used to examine the patient’s colon for bleeding and inflammation. Blood tests help to determine whether the pain is caused by an infection.
Overall, a comprehensive assessment needs to be conducted to make a final diagnosis. Considering the current information about the symptoms and the results of the objective assessment, several possible diagnoses can be identified. Lower left quadrant abdominal pain together with diarrhea can be characteristic of several diseases, and to determine the exact cause of pain, the patient’s blood should be tested, and computed tomography and colonoscopy should be performed.
References
Baid, H., Creed, F., & Hargreaves, J. (Eds.). (2016). Handbook of critical care nursing (2nd ed.). Oxford University Press.
Dong, L., & Zeng, R. (2019). Handbook of clinical diagnostics. Springer.
Gastroenteritis. (n.d.). Better Health. Web.
Payne, J. (2017). Left lower quadrant pain. Patient. Web.
Saliba, C., Diab, S., Nicolas, G., El Sayegh, J., Osman, D., Azzo, J. M., Dabbous, A., Hmadeh, H., Wehbe, A., & Ahmad, H. H. (2019). Pitfalls of diagnosing left lower quadrant pain causes: Making the uncommon common again. The American Journal of Case Reports, 20, 78–82. Web.