Discussion board – Description
Discussion 1A
You have a 48 year old woman presents to your office with complaints of abdominal pain after meals. She also complains of some distension and seems to link it to fatty foods. She has a history of HTN, which is well managed with a low dose beta blocker. Her history is otherwise unremarkable except for C-sections x3.
Vitals:
Temp 98.8
HR: 56
BP 128/86
RR: 16
Pain: 0
BMI: 38
Exam: She is calm and appropriate, non-toxic appearing.
Her abdominal exam is obese/soft/mildly tender. She has mild guarding in the right upper quadrant and her inspiration halts with deep palpation in this area. She has no rebound tenderness. The remainder of her examination is unremarkable.
What are your differential diagnoses? What would be your next step in terms of evaluation?
What is the difference between biliary colic/gall stones/cholangitis? How do their treatments differ?
You recommend a change in diet and she states that her abdominal pain and distention have improved after meals. She is also working on losing weight. She appreciates the advice you have given. However, a few months later she develops severe acute abdominal pain.
You see her in the emergency room and she has severe diffuse abdominal pain which radiates into her back and is associated with nausea/vomiting. She is afebrile but appears ill. Her exam is now remarkable for abdominal distention, guarding, and rebound tenderness diffusely.
What is your concern now in terms of diagnosis? What initial testing would you order and what would be your treatment? Do any scoring/prognostic systems exist to determine morbidity/mortality from this diagnosis?
Finally, is it a good idea to take her gall bladder out acutely?
Discussion 1B
Male GU Case Discussion
You have an elder gentleman coming in for his annual follow up. He is 78 years old and is very healthy and active for his age. As part of your screening your preform a digital rectal examination and check a PSA level. His exam is notable for an enlarged prostate but no palpable lumps or masses. His PSA is elevated but stable from last year at 6.0ng/ml.
What is PSA and why does the normal range increase with age?
When is it a useful test for helping to differentiate BPH versus prostate CA? When would referral for a biopsy be warranted?
Do most patients diagnosed with prostate cancer eventual die from it or something else?
NB: APA reference, 2 or more references for each question.
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