Chief Complaint: Nausea and RUQ painDemographics:African American, Male, master’s degree in accountingCurrent Medications:Albuterol inhaler 90mcg PRN wheezingPrevious Medical History:Childhood asthmaPrevious Surgical History:ACL surgery L knee at age 17Allergies:No known allergiesHPI:L.V. is an African American 30-year-old male who presented to your primary care officetoday with complaints of intermittent sharp right upper quadrant (RUQ) pain and nausea.Hestates that these symptoms occur about 1 hour after he eats and can last for hours after.L.V. ratesthe RUQ pain 6/10.He states this has been going on for two weeks.Patient reports that heworks as an accountant, and his job has become more demanding and stressful, and he admits toeating fast food 3-4x a week for the past 6 weeks. Due to his job, he also does not exerciseregularly.L.V. denies any recent illnesses.Risk Factors:Sedentary lifestyle, unhealthy eating habits (fatty foods), Stressful jobThree Differential Diagnoses:Bowel Obstruction, Diverticulitis, CholelithiasisSmall Bowel Obstruction occurs when there is intraluminal distention and peristalsisincreases to attempt to increase pressure to overcome the obstruction. (Tong et al., 2020).Themuscles get tired, and peristaltic activity stops.Impaired absorption from the obstruction causesdehydration, electrolyte imbalances, and can cause hypovolemic shock. (Tong et al., 2020).Some symptoms include worsening pain with abdominal tenderness, abdominal distention,
nausea, vomiting, constipation, and abnormal bowel sounds.(Tong et al., 2020).This could be apossible diagnosis due to the nausea and abdominal pain that L.V. is having.Diverticulosis is where there are small pouches of diverticula (mucosa) that project fromthe intestinal wall. (Bradshaw, 2023).This is more prevalent in older patients over the age of 65.This disease is usually asymptomatic, but in about 15-20% of patients it can turn into diverticulardisease, or acute diverticulitis.Symptoms include abdominal pain, diarrhea, fever, and bloating.(Bradshaw, 2023). This could be a possible diagnosis for L.V. due to the similarities in theabdominal pain, and location of pain.Cholelithiasis is the formation of gallstones.Gallstones form from the bile that isconcentrated in the gallbladder.These form when the components of the bile are not balanced.(Littlefield & Lenahan, 2019).There are three different categories of gallstones: cholesterol,pigmented, or mixed.Pigmented stones are black/brown and usually composed of calciumbilirubinate. (Littlefield & Lenahan, 2019).In 80% of people the stones are cholesterol stones,where the cholesterol concentration is too high. (Littlefield & Lenahan, 2019).If the stonesobstruct the bile ducts, they can experience painful spasms in the RUQ, referred to as biliarycolic.(Littlefield & Lenahan, 2019).The RUQ pain is what makes this a possible diagnosis aswell as the intermittent pain.
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