IHUMAN CASE # 4: GI Evita Alfonso - 48-year-old female CC: progressive, intermittent right upper quadrant pain

IHUMAN Case #4: GI Evita Alfonso - Understanding the Complexities of Right Upper Quadrant Pain

Introduction

The study of gastrointestinal disorders often presents with an intricate puzzle, requiring meticulous analysis to diagnose correctly. One such perplexing case is that of Evita Alfonso, a 48-year-old female, grappling with progressive, intermittent pain in her right upper quadrant. This case study explores the possible etiologies, diagnostic pathways, and therapeutic approaches pertinent to her symptoms.

Case Presentation

Evita Alfonso, at 48 years of age, reports experiencing intermittent, yet progressively worsening pain localized in the right upper quadrant of her abdomen. The discomfort described is of a piercing nature, exacerbating over a period, marked by its ebb and flow in intensity but steadily increasing in frequency. As a comprehensive exploration of her symptoms, various diagnostic modalities are employed to elucidate the underlying cause.

Symptomatology and Initial Hypotheses

The right upper quadrant (RUQ) pain, such as that experienced by Ms. Alfonso, could herald the presence of several potential pathologies. Among the most common are gallbladder-related ailments, notably cholecystitis or gallstones. Additionally, liver pathologies, including hepatitis or hepatomegaly, must be considered alongside pancreatic issues like pancreatitis.

Diagnostic Approach

In navigating the labyrinthine diagnostic pathway for RUQ pain, a multifaceted approach is adopted:

1. Clinical Examination: Comprehensive physical examinations focusing on the abdominal region, assessing for tenderness, swelling, and any abnormal masses.
2. Laboratory Tests: A series of blood tests to evaluate liver function (LFTs), pancreatic enzymes (amylase, lipase), and markers of infection or inflammation (CBC, CRP).
3. Imaging Studies: Ultrasound imaging remains the frontline modality given its efficacy in evaluating gallbladder and liver pathologies. Further, an MRI or CT scan could be requisitioned for a more detailed view, should initial findings warrant.

Differential Diagnosis

The differential diagnosis for Ms. Alfonso’s RUQ pain includes, but is not limited to:

• Cholecystitis: Inflammation of the gallbladder, often stone-induced, is a prime suspect given the symptom profile.
• Hepatobiliary Disease: Liver ailments, including fatty liver disease and hepatitis, could manifest similarly.
• Pancreatitis: Though less common, pancreatic inflammation must be considered, especially if digestive disturbances accompany the pain.

Treatment and Management

Upon confirmation of the diagnosis through the aforementioned investigative avenues, treatment for Ms. Alfonso would be tailored to the specific condition identified. For gallbladder issues, a cholecystectomy might be indicated if gallstones are present and symptomatic. Liver disorders may require pharmacological interventions, lifestyle changes, and possibly dietary modifications. In cases of pancreatitis, management typically involves hospitalization, ensuring hydration, pain control, and sometimes, intervention to remove blockages.

Conclusion

The case of IHUMAN case 4 GI Evita Alfonso is emblematic of the complexities inherent in gastrointestinal diagnostics. It underscores the necessity for a systematic approach to symptom evaluation, leveraging both traditional and advanced diagnostic tools to arrive at a precise diagnosis. Moreover, it highlights the importance of a personalized treatment plan, responsive to the evolving nature of the patient’s condition and the specifics of the diagnosed ailment.

In summary, while the case of Evita Alfonso presents with common symptoms, the investigative and management pathways underscore the nuanced understanding required to address such medical challenges effectively.

Below are sample Questions and Answers:

CC: 48 y/o F
Chief complaint is a short 1-2 statement or word
phrasefrom patient and should be listed in
“quotes”
“My stomach has been hurting really bad
overthe past 2 seeks”
HPI: pertinent s/s; +/- ROS/prior episodes/recent travel/ill contacts
Mrs. Alfonso is a 48-year-old female patient who presented to the clinic
with a progressive, intermittent right upper quadrant pain for the past 2
weeks and which has increased in severity in the past 2 days. The pain
radiates to the right shoulder. She also complains of associated symptoms
like nausea, vomiting, anorexia since the past 2 days. She has had
previous recurrent self-resolving symptoms over the last one year. Pain
used to be precipitated by fast food but notoccurs with all foods and
unresponsive with antacids and NSAIDS.
Onset: 2 weeks ago, with symptoms becoming more dreadful 2 days
ago Location: Right upper quadrant and occasionally radiated to the
right shoulderDuration: Pain has been constant since it started this
time; in the past it only lasted 1-2 days.
Character: Crampy gnawy achiness
Aggravating/alleviating factors: Pain gets worse with meals and
unresolvedwith antacids and NSAIDs
Related symptoms: Nausea. Vomiting, anorexia with onset of symptoms
2 daysago. Denies any recent exposure to other ill contacts. She has had
similar symptoms previously
Treatments: Has tried OTC antacids and ibuprofen without relief
Significance: Pain starts with a scale of 2-3 and gets up to 6-7. She
reports painhas kept her home from work.
PMHx child/adult
illness/hospitalizations/immunizations
Negative for any chronic illnesses. She
hasoccasional heartburn and arthritis
Frequent episodes of common colds and as
childNo hospitalizations, trauma or other
injuries
SurgHx type/when/why/complications
Tubal ligation