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case_summary_FamilyMedicine20_28-y.pdf - Family Medicine...

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Family Medicine 20: 28-year-old female with abdominalpainUser:Roxanne BarbeEmail:[email protected]Date:May 23, 2020 4:36AMLearning ObjectivesThe student should be able to:Conduct a culturally sensitive, empathic history.Appreciate the ways in which victims of violence may manifest symptoms and be alert to clues a patient may give that he/shehas been a victim of intimate partner violence.Discuss ways to assist the patient in developing a safety plan.Discuss reporting requirements for domestic violence.Appreciate a survivor’s perspective in an abusive relationship and the barriers to his/her seeking help.Apply knowledge of the differential diagnosis of abdominal and pelvic pain in evaluating the patient.KnowledgeSignificance of the Location of Abdominal PainThe location of the abdominal pain is important, as it can help narrow your differential diagnosis. For example, diffuse abdominalpain may represent gastroenteritis, whereas localized right lower quadrant pain is classic for but not limited to appendicitis. Thinkabout what is in the various quadrants of the abdomenwhen considering the differential diagnosis of abdominal pain.Red Flags of Life-Threatening Condition in Patient with Abdominal/Pelvic PainThere are more than many signs and symptoms of a life-threatening condition in a patient with abdominal or pelvic pain.Examples include:Abrupt onset of severe painShock with hypotension and tachycardiaDistensionPeritoneal irritation signsRigid abdomenPulsatile abdominal massAbsent bowel soundsFeverVomitingDiarrheaWeight lossMenstrual changesTrauma, prior surgeries, or operative scarsHistory/presence of blood in emesisHistory/presence of blood in stoolSeverity of the painEcchymoses/bruisingRebound tendernessMass or ascitesObstetrical HistoryGGravidaor number of pregnanciesTNumber of TermpregnanciesPNumber of PreterminfantsANumber of spontaneous or inducedAbortions© 2020 Aquifer1/9
LNumber of LivingchildrenDocumenting Follow-Up & Lab ReportingDocumentation of attempts to schedule follow-up visits and inform patients of laboratory results is very important.Abdominal Pain HistoryLocationQualitySeverityTimingAggravating factors and alleviating factorsSome causes of abdominal pain in primary careConstipation- Patients may give a history of having small, hard pellets for stools, decreased frequency of stooling, harder stoolsthan usual or occasionally, having loose stools, which may actually signify an impaction, where the patient actually has soft stoolleaking around an impacted hard stool. Our patient has indicated that her bowel movements are alternating in consistency fromloose to hard to normal. Constipation is unlikely to be her primary diagnosis. This type of stooling pattern is more often associatedwith irritable bowel syndrome.

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Term
Summer
Professor
Dr Blessing Isiguzo
Tags
intimate partner violence

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