Let's study Medical English. ABDOMINAL PAIN.P1
ABDOMINAL PAIN – Part 1
You are going to observe and participate in a clinical encounter of a patient who comes to the office with a complaint of abdominal pain.
As you observe the encounter, you will be asked to answer questions while the image on the screen freezes. Such questions will allow you to practice history taking and physical examination skills as well as your clinical reasoning skills in developing an assessment or differential diagnosis, and a plan—that is, an appropriate next diagnostic workup.
You will have the opportunity to record your findings and receive immediate feedback.
HEALTH HISTORY
So, what brings you in today?
Well actually I’m a little worried. I had this pain about two days ago in the upper, middle section of my abdomen and it seems to be spreading to my back.
What possible causes of abdominal pain are you considering?
Gastritis.
Peptic ulcer.
Acute pancreatitis.
GERD.
Abdominal aortic aneurysm.
Do you have the pain now?
Yeah, and it seems to be getting worse. It’s like a burning in my belly and then when I cough it just seems to get worse.
How severe would you say the pain is, on a scale of 1 to 10, with 1 being faint and 10 being very severe?
Oh, I’d say at least an 8 out of 10.
What does it feel like?
Well its steady, I mean it never seems to go away. It’s sharp through to my back. And it just seems to be burning all the time.
When did you first get this pain?
Two days ago. And I remember that. That was the day that I was served my divorce papers at work. Man, I guess I’m having some luck.
So the pain happened at work then?
No, no I left work, and I stopped had a drink…or two…well…more than two I guess. But the pain came on that night. And um…so I took some Tums and I did feel a little better for a little while. But then it came on again and it was worse. It went to my back. I guess it lasted for about an hour or two then it stopped.
Have you ever had a pain like this before?
Well, I’ve had, you know, stomach pain off and on for the past 6 months.
Are there any triggers for the pain, like stress or specific foods?
Well, you know I’m a stock broker, so that’s pretty stressful. And this whole thing about separating from my wife right now, that isn’t helping. But I tell you, I do try and avoid spicy foods because that tends to kind of like, stir up my stomach.
Is there anything that makes the pain better?
Well, I find if I lie still and maybe draw my legs up. And I have tried Motrin and Advil, but that doesn’t help too much.
Is there anything that makes the pain worse?
Oh, just any movement. I mean, just even walking.
Have you had any dark stools or any with bright red blood in them?
I haven’t noticed anything.
How about any blood in the urine?
Not that I’ve noticed.
What about smoking?
Oh…probably…a pack and a half a day.
Well, you mentioned having a few drinks earlier. What would you say is your normal intake?
Maybe…probably 4 or 6 beers a day. Or…maybe 2 to 4 drinks a day. I mean, it’s been a pretty tough 6 months. I just need to relax at night.
What further questions would you have in light of this drinking pattern?
The following questions would be helpful:
Have you ever had a drinking problem?
When was your last drink?
Do you feel you have a problem with drinking now?
These questions from the CAGE questionnaire are highly sensitive and specific for problem drinking. Two or more affirmative answers to all four questions have a sensitivity of 43%‐84% and specificity of 70%‐96% for alcohol misuse.
Are you at all concerned about your drinking? Have you ever had a drinking problem?
Well, I know I drink too much but I can’t deal with that right now. Well, I did have a problem in college, but…and I guess I did have a DWI.
Well, how would you say your spirits are in general?
I’d say…pretty down right now.
Have you had any other medical problems?
Hmmm…no. I didn’t even have any surgeries.
Well, let’s do your physical examination, and then we can talk more.
With the patient’s health history in mind and after good hand hygiene, you are ready for the physical examination.
Sài gòn 4/1/2023
TS.BS ĐỖ MINH HÙNG