patient care report for epigastric pain male

A 48-year-old male patient was presented to the emergency department with complaint of epigastric pain and melena that had started 3 days ago. The pain had started suddenly and progressed and after a while, he had passed melena stool. He also mentioned some episodes of vomiting that was not bloody.

Full Answer

How is epigastric pain diagnosed and treated?

Pain when you eat, or pain that is relieved when you eat or have a bowel movement How is epigastric pain diagnosed and treated? Your healthcare provider will feel your abdomen to see if it is tender or rigid. He may change or stop any medicine you are taking that is causing your pain.

When should I go to the ER for epigastric pain?

See your doctor right away if your epigastric pain is severe, ongoing, or interfering with your daily life. You should go to the emergency room if you have any of the following symptoms: trouble breathing or swallowing. throwing up blood. blood in your stool or black, tarry stool. high fever. chest pain. difficulty breathing.

What happens if you have pain in your epigastric region?

Failure to comply may result in legal action. Epigastric pain is felt in the middle of the upper abdomen, between the ribs and the bellybutton. The pain may be mild or severe. Pain may spread from or to another part of your body. Epigastric pain may be a sign of a serious health problem that needs to be treated.

How do you assess a patient with abdominal pain?

The American College of Radiology has recommended different imaging studies for assessing abdominal pain based on pain location. Ultrasonography is recommended to assess right upper quadrant pain, and computed tomography is recommended for right and left lower quadrant pain.

What assessment findings might you find in a patient complaining of abdominal pain?

Abdominal assessment may reveal a mass in the right lower quadrant that is tender to palpation, or signs of peritoneal irritation such as rebound, involuntary guarding and abdominal wall muscle spasms. Any movement of the patient (e.g., bumping the stretcher) may elicit severe pain.

How do you describe epigastric pain?

Epigastric pain is pain that is localized to the region of the upper abdomen immediately below the ribs. Often, those who experience this type of pain feel it during or right after eating or if they lie down too soon after eating.

What questions should you ask a patient with abdominal pain?

Some other important questions to ask the patient include:Have you ever had this pain before? ... Are there associated symptoms, such as nausea and vomiting and/ or diarrhea?Have you noticed any black stools or blood in your stool? ... Have you noticed blood in your urine?Do you feel as though you have had a fever?More items...

How do you document a gastrointestinal assessment?

Documentation of a basic, normal abdominal exam should look something along the lines of the following: Abdomen is soft, symmetric, and non-tender without distention. There are no visible lesions or scars. The aorta is midline without bruit or visible pulsation.

How do you do a gastrointestinal assessment?

Light palpation is helpful for assessing for tenderness. Perform deep palpation to check the abdominal masses....To deeply palpate the abdomen:Use the palmer side of the hand.Palpate all four quadrants.Assess for masses noting the location, size, and shape.Check for tenderness.

What is the most common cause of epigastric pain?

Gastritis is a common cause of epigastric pain. It is often worse after eating and will generally improve with proton pump inhibitors. Test for the presence of Helicobacter pylori. Peptic ulcer tends to cause acute or chronic gnawing or burning pain.

What are the common causes of epigastric pain?

Epigastric pain risk factors include a history of peptic ulcer disease, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, heavy alcohol consumption, and overeating.

What is cause of epigastric pain?

The stomach is very flexible. However, eating more than necessary causes the stomach to expand beyond its normal capacity. If the stomach expands considerably, it can put pressure on the organs around the stomach and cause epigastric pain. Overeating can also cause indigestion, acid reflux, and heartburn.

What information would you want to obtain when taking history on a client with abdominal pain?

Let's discuss the questions to ask your patient when taking a detailed history. These questions should focus on aspects that are most pertinent to abdominal pain or symptoms....How to obtain a detailed patient history for abdominal painPast medical history.Past surgical history.Family history.Social history.

When examining a patient with abdominal pain the nurse in charge should assess?

If the patient is experiencing abdominal pain, the nurse should ascertain its location, duration, intensity, factors that make it worse, and factors that make it better.

Why do we assess for abdominal pain?

Article Sections. Acute abdominal pain can represent a spectrum of conditions from benign and self-limited disease to surgical emergencies. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies.

What is the name of the hole in the stomach that the esophagus passes through?

A hiatal hernia happens when part of your stomach gets pushed up towards your diaphragm through the hole that the esophagus passes through, which is called the hiatus. Hiatal hernias don’t always cause pain or discomfort. Common symptoms of a hiatal hernia can include: indigestion.

Why does my epigastric pain feel so bad after eating?

It can also make it hard to breathe because your lungs have less room to expand when you inhale. Overeating can also cause stomach acid and contents to back up into your esophagus. This can cause heartburn and acid reflux. These conditions can make the epigastric pain that you feel after eating much worse.

Why does my gallbladder hurt?

Gallbladder inflammation or gallstones. Epigastric pain can develop when your gallbladder becomes inflamed as gallstones block the opening of your gallbladder. The condition is known as cholecystitis. This can be painful and may require hospitalization or surgery.

What are the symptoms of peptic ulcers?

Common symptoms of peptic ulcer disease can include: nausea. vomiting.

What to do if your epigastric is hurting?

Your doctor may recommend antacids or even acid-blocking medicines to relieve your pain. If an underlying condition such as GERD, Barrett’s esophagus, or peptic ulcer disease is causing your epigastric pain, you may require antibiotics as well as long-term treatment to manage these conditions.

What is the pain in the upper abdomen?

Epigastric pain is a name for pain or discomfort right below your ribs in the area of your upper abdomen. It often happens alongside other common symptoms of your digestive system. These symptoms can include heartburn, bloating, and gas. Epigastric pain isn’t always cause for concern.

What does it mean when you have trouble swallowing?

having trouble swallowing or having pain when swallowing. 8. Gastritis. Gastritis happens when the lining of your stomach (mucosa) becomes inflamed due to a bacterial infection, an immune system disorder, or ongoing damage to your stomach.

What causes pain in the stomach?

Certain foods may cause your pain, such as alcohol or foods that are high in fat. You may need to eat smaller meals and to eat more often than usual. Drink liquids as directed. Ask how much liquid to drink each day and which liquids are best for you. Do not have drinks that contain alcohol or caffeine.

How to keep track of pain?

Also include any foods you ate or activities you did before the pain started. Keep track of anything that helped the pain. Eat a variety of healthy foods.

What does it mean when you have epigastric pain?

Pain may spread from or to another part of your body. Epigastric pain may be a sign of a serious health problem that needs to be treated.

What are the conditions that cause a heart attack?

Heart problems, such as a heart attack. Digestion problems, such as indigestion, GERD, or lactose intolerance. Medical conditions, such as an ulcer, a hernia, irritable bowel syndrome (IBS), or cancer. A blockage in your bowels or gallbladder. A bladder infection.

How do you know if you have a heart attack?

You have any of the following signs of a heart attack: Squeezing, pressure, or pain in your chest. You may also have any of the following: Discomfort or pain in your back, neck, jaw, stomach, or arm. Shortness of breath.

What are the symptoms of a swollen stomach?

Signs and symptoms will depend on what is causing your pain. Nausea, vomiting, bloating, constipation, or diarrhea. Loss of appetite, weight loss, feeling of fullness as you start to eat. Movement relieves the pain or makes it worse, or only certain positions are comfortable.

Can pain go away without treatment?

Your pain may go away without treatment, or you may need any of the following: Medicines may be given to treat pain or stop vomiting. You may also need medicines to reduce or control stomach acid, or treat an infection. Blood or urine tests may show problems such as infection or inflammation.

Summary

A 50-year-old man presents to the emergency department with epigastric pain and is found to have severe hypertension on clinical examination. After admission to hospital, further investigation with CT imaging reveals the patient has an uncomplicated splenic artery dissection.

Background

Splenic artery dissection is an extremely rare disease with only 13 previously reported cases in the literature. However, we believe this is the first reported case of an uncomplicated spontaneous splenic artery dissection diagnosed in vivo.

Case presentation

A 50-year-old man presented to the emergency department with a sudden onset of severe epigastric pain. The pain was sharp, 7 of 10 in severity and radiated to the left hypochondrium and the back. He had noticed a recent increased frequency of headaches.

Investigations

After a period of observation, in light of the history and examination findings it was felt that investigation with a CT aortogram was necessary to exclude aortic dissection. This revealed normal precontrast and postcontrast images of the thoracic and abdominal aorta.

Treatment

There is little published literature on spontaneous splenic artery dissection. 1–3 However, based on the evidence base available on treatment of other similar types of dissection, the vascular surgeons recommended anticoagulation for a minimum of 3 months with Warfarin. Other management included blood-pressure-lowering agents.

Outcome and follow-up

The patient was discharged with endocrinology and vascular surgery outpatient follow-up. Further investigations carried out excluded secondary causes of hypertension.

Discussion

Isolated splenic artery dissection is extremely rare and is usually reported as a postmortem finding. Indeed on review of current literature, we found only 13 reported cases of splenic artery dissection, 12 of which were discovered on postmortem.

What is the Meckel's diverticulum?

Meckel’s diverticulum is a true diverticulum comprised of all 3 layers of the gastrointestinal (GI) tract including mucosa, submucosa, and adventitia.[2] Meckel’s diverticulum usually consists of heterotopic tissue, most commonly gastric mucosa, due to the pluripotential cell line of the omphalomesenteric duct.

What is the diverticulum?

The diverticulum can also serve as a lead for point for an ileocolic or ileoileal intussusception as well as a turning point for a volvulus. If symptomatic, patients typically complain of crampy, right lower quadrant abdominal pain.

What tissue is found on a Meckel's diverticulum?

Other heterotopic tissue found on pathological specimens of Meckel's diverticulum may include pancreatic, jejunal, duodenal, and less commonly, colonic, rectal, or endometrial. Epidemiologically, Meckel’s diverticulum tends to follow the rule of 2s:[2] Occurs in 2% of the population.

Can diverticulum be inflamed?

Finally, erosion of nearby intestinal mucosa or inflammation of the diverticulum itself can lead to perforation or the diverticulum itself can become inflamed leading to diverticulitis. [3] Evaluation of a patient with suspected complications from Meckel's diverticulum includes multiple options.

Can pertechnetate be detected by gamma camera?

The pertechnetate will be absorbed by the gastric mucosa and will be detected when scanned by a gamma camera. This is the preferred scan due to ease and accuracy; however false negative tests do occur if the diverticulum is comprised of other tissue other than gastric mucosa.

Can you remove Meckel's diverticulum?

Although relatively rare, serious complications can arise in someone with Meckel's diverticulum and the definitive treatment is a surgical intervention for removal and repair. Meckel's diverticulum is often an incidental finding, and if found during surgery, removal is typically up to the discretion of the surgeon.

Is abdominal pain a common complaint in the emergency department?

Abdominal pain is an extremely common complaint in the emergency department with a large differential ranging from very benign etiologies to life-threatening emergencies . Keeping a large differential can help guide diagnosis and treatment options.

How to keep track of pain?

Include when the pain starts, how long it lasts, and if it is sharp or dull. Also include any foods you ate or activities you did before the pain started. Keep track of anything that helped the pain.

What causes pain in the stomach?

Certain foods may cause your pain, such as alcohol or foods that are high in fat. You may need to eat smaller meals and to eat more often than usual. Drink liquids as directed. Ask how much liquid to drink each day and which liquids are best for you. Do not have drinks that contain alcohol or caffeine.

What does it mean when you have epigastric pain?

Pain may spread from or to another part of your body. Epigastric pain may be a sign of a serious health problem that needs to be treated.

How do you know if you have a heart attack?

You have any of the following signs of a heart attack: Squeezing, pressure, or pain in your chest. You may also have any of the following: Discomfort or pain in your back, neck, jaw, stomach, or arm. Shortness of breath.

How long do you have symptoms of a fever?

You vomit often or several times in a row. You lose weight without trying. You have symptoms for longer than 2 weeks.