NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS

NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS
Sample Answer for NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS Included After Question

Practicum Applications must be submitted in a timely manner to ensure that your Preceptor and Practicum Site meet the requirements of the College of Nursing and Walden University. For this Assignment, you will either submit your Practicum Application or you will submit a revised/updated Practicum Plan that indicates when you plan to take the Practicum courses.

To Prepare
Review the Practicum Application Deadlines found on the College of Nursing Field Experience website to determine when you need to submit your Practicum Application.
Review the Practicum Application Tutorial for submitting applications in Meditrek.
Meditrek Credentials (Username and Password):
Your credentials have been emailed to your Walden student email address. Search your Walden student issued email to locate the email from support@meditrek.info. (Note: Do not email Meditrek directly, please use the following methods if you are unable to locate your Meditrek credentials.)
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If you are unable to reset your password online, call the Customer Care Team Support at 800-925-3368 or live chat via your student portal.
The Assignment:

You must complete either Part 1 or Part 2 of this Assignment:

Part 1: Practicum Application
Login into Meditrek and complete your Practicum Application. When the application is complete, submit it and create a PDF of the confirmation email you received.
Part 2: Practicum Plan
Using the affiliation agreement search within Meditrek and identify potential Practicum Sites that are in your area to assist you in identifying potential Preceptors.
Complete the Practicum Plan form found in Meditrek, submit it and create a PDF of the confirmation email you received.
By Day 7 of Week 10

Submit either your Practicum Application or Practicum Plan submission confirmation email PDF.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK10Assgn2+last name+first initial.(extension)” as the name.
Click the Week 10 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
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Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn2+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
A Sample Answer For the Assignment: NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS
Title: NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS

The SOAP note represents the subjective and objective findings of JR, a 47-year-old male presenting with symptoms of generalized abdominal pain and diarrhea. This paper aims to analyze the subjective, objective, and assessment portion of the SOAP note. The appropriate diagnostic tests and differential diagnoses for this case study will also be discussed.  

Analysis of the Subjective Portion  

HPI: The HPI states that the patient has generalized abdominal pain that had its onset three days ago. The severity of the pain has also be provided, and an associated symptom of nausea after eating. However, the HPI has missing information on the character of the abdominal pain, whether it is dull or sharp, radiating or non-radiating, and whether constant or intermittent. Additional information should also be provided on the presence or absence of other associated symptoms with the abdominal pain. In addition, factors that aggravate or relieve abdominal pain should have been provided. The HPI should also state whether the patient took any non-pharmacological interventions to relieve the pain and the degree of relief.  

The HPI has not addressed the history of diarrhea. Information on the onset of diarrhea should have been indicated, including whether it was acute or gradual. Besides, the HPI should describe the character of diarrhea, including the frequency of loose stools per day, consistency, color, and volume of stools, or whether bloody or non-blood (Desselberger, 2017). Furthermore, associated enteric symptoms such as nausea, vomiting, fever, or rectal bleeding should be indicated. The HPI should also address food ingestion history or travel history that could have contributed to diarrhea (Desselberger, 2017). Factors that trigger or relieve diarrhea should also be provided, and any non-pharmacological measures the patient took to control diarrhea. 

PMH: The PMH states that the patient has a history of Hypertension, Diabetes, and GI bleed four years ago. However, information on when the patient was diagnosed with Hypertension and Diabetes should be indicated and whether the Hypertension is controlled or uncontrolled. 

Medications: Information on the patient’s current medications and the dosage has been included. However, additional information on the frequency of each drug should be provided. The subjective portion should also include additional information on past surgical and immunization history. 

The social and personal history should include additional information, including the patient’s occupation, interests, the performance of ADLs, exercise, sleeping and eating habits, safety measures, and health promotion activities. The subjective portion has not included the review of systems that presents other symptoms the patient has that have not been included in the chief complaint and the HPI.   

Analysis of the Objective Portion  

The objective portion has provided vital signs measurements and physical findings of the heart, lungs, skin, and abdomen.  However, it has not addressed the general patient’s survey findings. This entails the patient’s general state of health, level of conscience, dressing, grooming, and hygiene. The patient’s attitude towards the examiner, facial expressions, eye contact, affect, and mannerism should also be included. Besides, the general survey should provide information on the patient’s motor activity, posture, balance, and gait. This being a focused abdominal assessment, the abdominal exam findings are incomplete. It should have included detailed exam findings from the inspection, auscultation, percussion, and auscultation of the abdomen.  

Additional information on the inspection findings should be provided, including contour, symmetry, pigmentation, scars, respiratory movements, and visible peristalsis. Auscultation findings should be included, such as the presence of bruits and friction rubs. Furthermore, percussion findings, including areas of tympany or dullness, liver span, the distance of the spleen from the left coastal margin, and tenderness on percussion, should be indicated. Additional information on palpation findings such as the presence of masses, muscle guarding, organ enlargement, or rebound tenderness should also be included in the abdominal exam. 

Analysis of Assessment Portion 

The assessment findings include Left lower quadrant pain and Gastroenteritis. Left lower quadrant pain is only supported by the objective findings but not the subjective information. In the subjective history, the patient reports experiencing moderate generalized abdominal pain, and the specific quadrant has not been indicated.  

Gastroenteritis is supported by subjective information of generalized abdominal pain and diarrhea. Objective findings that support Gastroenteritis include a mild fever of 99.8 F, hyperactive bowel sounds, and pain on the left lower quadrant.   

Appropriate diagnostic tests  

Diagnostic tests appropriate to make a diagnosis for this case include: 

Complete Blood Count (CBC): A CBC test will establish the white blood cell count to assess leukocytosis. An elevated white blood cell count will indicate an underlying infection or inflammation (Mealie & Manthey, (2019). Mild leukocytosis will point to a viral infection, while a high white blood cell count will indicate a bacterial infection. 
Abdominal Ultrasound:  An abdominal ultrasound will help in visualizing the presence of inflammation or organ enlargement of abdominal organs (Mealie & Manthey, (2019). 
Stool culture: A stool culture will establish the presence of pathogens that could be the causative agent of diarrhea (Desselberger, 2017).  
Differential Diagnoses 

The differential diagnoses in the assessment portion are Left lower quadrant pain and Gastroenteritis.  I would reject the diagnosis of Left lower quadrant pain because this is a physical sign rather than a diagnosis. The left lower quadrant pain is a sign that suggests an underlying problem in an organ in the left lower quadrant, thus ruling it out as a differential diagnosis.  I would accept Gastroenteritis as a differential diagnosis based on the patient’s history of generalized abdominal pain, diarrhea, low-grade fever, and hyperactive bowel sounds. 

Conditions that may be considered as differential diagnoses for this patient include: 

Diverticulitis 

Diverticulitis is characterized by inflammation or infection of the diverticula, which are small pouches in the colonic wall (Onur et al., 2017). Diverticulitis can either be complicated or uncomplicated. Uncomplicated diverticulitis occurs without any associated complications. On the other hand, complicated diverticulitis occurs due to the formation of an abscess, fistula, bowel obstruction, or frank perforation (Swanson & Strate, 2018).  The clinical manifestations of Diverticulitis include abdominal pain, which commonly occurs in the left lower quadrant (Onur et al., 2017). The abdominal pain can be constant or intermittent.  

Abdominal pain is associated with a change in bowel patterns, which can either be diarrhea or constipation (Swanson & Strate, 2018).  Fever is usually present in the case of an abscess or perforation. Other symptoms that present in diverticulitis include nausea, vomiting, flatulence, and abdominal bloating.  

On physical examination, there is hypo-or hyperactive bowel sounds, tympanic abdomen on percussion, abdominal distension, and localized tenderness to palpation over the area of inflammation (Onur et al., 2017). A tender mass may be perceived if an abscess is present. Besides, patients can present with abdominal rigidity, guarding, or rebound tenderness with diverticular perforation.  

Diverticulitis is a differential diagnosis based on the patient’s history of abdominal pain, diarrhea, nausea, low-grade fever, hyperactive bowel sounds, and tenderness on the left lower quadrant. 

Acute Viral Gastroenteritis 

Acute Viral Gastroenteritis (GE) refers to infection of the gastrointestinal tract by viral pathogens such as Rotavirus and norovirus (Desselberger, 2017). The primary manifestation of viral GE is diarrhea, which occurs as loose or watery diarrhea consisting of 3 or more bowel movements in a day (Stuempfig & Seroy, 2019). Other symptoms may include nausea, vomiting, fever, and abdominal pain.  The symptoms typically last for less than a week and usually improve within 1 to 3 days (Stuempfig & Seroy, 2019). The symptoms have a sudden onset and may vary from mild to severe. Patients commonly present with mild fever, mild abdominal pain, and mild, diffuse abdominal tenderness (Desselberger, 2017). Vomiting is present in most, but not all cases. 

Acute Viral GE is a differential diagnosis based on pertinent positive findings of abdominal pain, diarrhea, nausea, low-grade fever, hyperactive bowel sounds, and abdominal tenderness.

NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS
Irritable Bowel Syndrome 

Irritable Bowel Syndrome (IBS) is defined as abdominal pain or discomfort with altered bowel habits, either diarrhea, constipation, or both (Weaver, Melkus & Henderson, 2017). Common sites of abdominal pain include lower abdomen particularly left lower quadrant. Meals trigger pain while defecation alleviates the pain. Other common symptoms of IBS include bloating, distention, nausea, vomiting, anorexia, fever, rectal bleeding, and steatorrhea (Weaver, Melkus & Henderson, 2017). IBS is a differential diagnosis based on pertinent positive findings of abdominal pain, diarrhea, nausea, low-grade fever, and left lower quadrant pain.  

References

Desselberger U. (2017). Viral gastroenteritis. Medicine (Abingdon, England: UK ed.), 45(11), 690–694. https://doi.org/10.1016/j.mpmed.2017.08.005 

Mealie, C. A., & Manthey, D. E. (2019). Abdominal exam. In StatPearls [Internet]. StatPearls Publishing. 

Onur, M. R., Akpinar, E., Karaosmanoglu, A. D., Isayev, C., & Karcaaltincaba, M. (2017). Diverticulitis: a comprehensive review with usual and unusual complications. Insights into Imaging, 8(1), 19–27. https://doi.org/10.1007/s13244-016-0532-3 

Stuempfig, N. D., & Seroy, J. (2019). Viral Gastroenteritis. In StatPearls [Internet]. StatPearls Publishing. 

Swanson, S. M., & Strate, L. L. (2018). Acute Colonic Diverticulitis. Annals of internal medicine, 168(9), ITC65–ITC80. https://doi.org/10.7326/AITC201805010 

Weaver, K. R., Melkus, G. D., & Henderson, W. A. (2017). Irritable Bowel Syndrome. The American journal of nursing, 117(6), 48–55. https://doi.org/10.1097/01.NAJ.0000520253.57459.01 

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Week 6: Assessment of the Abdomen and Gastrointestinal System

On your way home from dinner, you start experiencing sharp pains in your abdomen. You ate seafood—could you have food poisoning? What else might be causing your pain? Appendicitis? Should you head to the emergency room, or should you wait and see how you feel in the morning?

Numerous ailments can affect the GI system and the abdomen. Because the organs are so close, it can be difficult to conduct an accurate assessment. Also, pain in another area of the body can affect the GI system. For example, patients with chronic migraines often report nausea.

This week, you will explore how to assess the abdomen and gastrointestinal system.

Learning Objectives
Students will:
Evaluate abnormal abdomen and gastrointestinal findings
Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the abdomen and gastrointestinal system
Analyze chest X-Ray and abdominal X-Ray imaging
Identify concepts, theories, and principles related to advanced health assessment
Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 6, “Vital Signs and Pain Assessment”This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.

Chapter 18, “Abdomen”In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 3, “Abdominal Pain”
This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.

Chapter 10, “Constipation”
The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.

Chapter 12, “Diarrhea”
In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.

Chapter 29, “Rectal Pain, Itching, and Bleeding”
This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.

Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Chabok, A., Thorisson, A., Nikberg, M., Schultz, J. K., & Sallinen, V. (2021). Changing paradigms in the management of acute uncomplicated diverticulitis. Scandinavian Journal of Surgery, 110(2), 180–186. https://doi.org/10.1177/14574969211011032

Hussein, A., Arena, A., Yu, C., Cirilli, A., & Kurkowski, E. (2021). Abdominal pain in the elderly patient: Point-of-care ultrasound diagnosis of small bowel obstruction. Clinical Practice and Cases in Emergency Medicine, 5(1), 127–128. https://doi.org/10.5811/cpcem.2020.11.50029

Document: Midterm Exam Review (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.

Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid”This chapter explores the health assessment processes for the abdomen, perineum, anus, and rectosigmoid. This chapter also examines the symptoms of many conditions in these areas.
Chapter 10, “The Urinary System”In this chapter, the authors provide an overview of the physiology of the urinary system. The chapter also lists symptoms and conditions of the urinary system.

Required Media (click to expand/reduce)

Assessment of the Abdomen and Gastrointestinal System – Week 6 (14m)

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 17 that relate to the assessment of the abdomen and gastrointestinal system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/

Assignment 1: Lab Assignment: Assessing the Abdomen

Photo Credit: Getty Images/Hero Images

A male went to the emergency room for severe midepigastric abdominal pain. He was diagnosed with AAA ; however, as a precaution, the doctor ordered a CTA scan.

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

With regard to the Episodic note case study provided:
Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Analyze the objective portion of the note. List additional information that should be included in the documentation.
Is the assessment supported by the subjective and objective information? Why or why not?
What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
By Day 7 of Week 6

Submit your Lab Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK6Assgn1+last name+first initial.(extension)” as the name.
Click the Week 6 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
Click the Week 6 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK6Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 6 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 6 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 6

To participate in this Assignment:

Week 6 Assignment 1

Exam: Week 6 Midterm Exam

This exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

This exam will be on topics covered in weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.

By Day 7 of Week 6

Submit your Midterm Exam.

Submission and Grading Information
Submit Your Midterm Exam by Day 7 of Week 6.

To Complete this Exam:

Week 6 Exam

Assignment 2: Lab Assignment DCE

The causes of abdominal pain can be extremely varied due to the sheer number of structures, organs, and functions within the abdomen. If abdominal pain is caused by a life-threatening condition, then swift and accurate assessment is essential.

In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing an abdominal examination this week.

Focused Exam: Abdominal Assignment:
Complete the following in Shadow Health:
Abdominal  Concept Lab (Required)
 Gastrointestinal (Practice)
Focused Exam: Abdominal Pain (Practice)
What’s Coming Up in Week 7?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will explore how to assess the heart, lungs, and peripheral vascular system as you complete your Discussion.

Week 7 Required Media

Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images

Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.

A Sample Answer 2 For the Assignment: NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS
Title: NURS 6512 Assignment 1 Lab Assignment Assessing the Abdomen INS

The abdominal compartment situated between the thorax and pelvis houses the gastrointestinal system as well as other organs such as the kidneys and spleen. The abdomen and the gastrointestinal system encounter physiologic disturbances resulting in several pathologies that range in severity from mild to life-threatening. Consequently, clinical assessment of the abdomen and gastrointestinal system is imperative to assist in prompt diagnosis of these pathologies and initiation of the necessary therapeutic approaches. This paper will explore a case study concerning LZ, a 65-year-old African American male who presents to the emergency department with a two-day history of epigastric pain radiating to the back. The subsequent paragraphs will explore subjective and objective details as well as the assessment of this case scenario.

Subjective

LZ presents with a sudden onset two-day history of intermittent epigastric pain that radiates to the back. The pain has persisted despite the use of proton pump inhibitors. However, he reports an increase in severity and vomiting although there is no associated fever or diarrhea. Epigastric abdominal pain is a non-specific symptom that may indicate both gastrointestinal and non-gastrointestinal etiologies. Consequently, further evaluation is required, and the additional history to inquire about the history of presenting illness includes the following: The character of the pain must be mentioned since some pathologies present with sharp pain while others present with a colicky pain. Similarly, it is important to ask about the timing of the pain. For instance, if it is worse at any particular time of the day. Factors aggravating and relieving the pain provide an important clue to the underlying etiology. Consequently, it is worth inquiring about the effects of a change of position on the pain. For instance, if it is worse or better in any distinct position. Similarly, noting the impact of eating on the pain is equally important.

Associated factors are crucial as most pathologies that present with epigastric pain also manifest with other symptoms. Apart from fever and diarrhea, questions regarding symptoms such as cough, chest pain, nausea, anorexia, hematuria, hematemesis, bloating, belching, nocturnal pain, indigestion, weight loss, dizziness, diaphoresis, anxiety, and alterations in bowel habits must be raised. LZ also vomited after taking his lunch. Subsequently, additional questions to ask include the number of episodes, constituents, amount, and the color of the vomitus, if other family members who ate the same meal vomited, and associated factors since vomiting is a non-specific symptom. Other parts of history that are considered significant include history of medication use particularly NSAIDs, steroids, and anticonvulsants among others, history of trauma, nutritional history including the diet and caffeine intake, and family history of similar presentation.

Additionally, LZ has a positive history of hypertension, hyperlipidemia, and GERD as well as a history of alcohol and smoking. The aforementioned factors are regarded as significant risk factors underlying several gastrointestinal pathologies. Consequently, it is important to quantify both smoking and alcohol intake and determine if the blood pressure and hyperlipidemia are well controlled. Finally, it is necessary to ask if he is stressed following divorce.

Objective

The analysis of the vital signs demonstrates that LZ with a blood pressure of 91/60 mmHg is hypotensive since he is a known hypertensive patient on metoprolol. Similarly, he is overweight which carries moderate health risks. The respiratory, dermatological, and cardiovascular systems revealed no abnormalities. Nevertheless, exhaustive examination with regards to inspection, palpation, auscultation, and percussion is crucial, particularly for the chest. auscultation particularly for the chest Findings noted on the abdominal exam include tenderness in the epigastric area with guarding although no masses or rebound tenderness. Additional features that are crucial to highlight in the physical examination include the general exam which focuses on the general appearance of the patient. Similarly, a detailed abdominal examination including comprehensive findings on auscultation, inspection, palpation, and percussion is crucial since different diseases present with different abdominal signs. Finally, a neurological examination is also significant as vomiting can be a manifestation of neurologic disease.

Assessment

Investigations necessary to assist in the diagnosis of his condition and rule out other causes of epigastric pain include both laboratory and radiological studies. Laboratory investigations include complete blood count with differential, urea, creatinine, and electrolytes, liver function tests, coagulation profile, serum amylase, and lipase levels, ESR/CRP, procalcitonin, blood glucose levels, LDH, lactate levels, serum triglycerides, calcium levels, stool for H. pylori antigen, and serum gastrin levels. The abovementioned laboratory tests are vital in evaluating the common causes of epigastric pain radiating to the back such as acute pancreatitis and peptic ulcer disease (Patterson et al., 2022).

On the other hand, imaging tests include ECG to rule out pericarditis, abdominal ultrasound to check for gallstones, liver or renal problems, abdominal X-ray which may reveal pneumoperitoneum in the case of a perforated ulcer, Chest X-ray and CT thorax, abdomen and Pelvis to identify possible pancreatitis and abdominal aortic aneurysm (Patterson et al., 2022). Finally, endoscopy is critical as both GERD and peptic ulcer disease are possible differentials.

Abdominal aortic aneurysm, acute pancreatitis, and perforated peptic ulcer are among the potential diagnosis for LZ’s presentation. Abdominal aortic aneurism refers to focal dilatation of the abdominal aorta to more than 1.5 times its ordinary diameter (Sakalihasan et al., 2018). Predisposing factors for this condition include advanced age, smoking, arterial hypertension, and hypercholesterolemia which LZ possesses (Sakalihasan et al., 2018). It is usually asymptomatic but may present with epigastric pain radiating to the back and pulsatile abdominal mass. A perforated peptic ulcer is another possible cause of his symptoms. Peptic ulcer disease shares similar risk factors as GERD including alcohol use and smoking. Psychological stress probably due to divorce is also a risk factor. The patient usually presents with epigastric pain which may radiate to the back. However, if perforated, features of peritonitis such as tenderness and guarding may be evident with no palpable mass (Malik et al., 2022)