Assessing the Abdomen
History to be collected from the patient
From the complaints of diarrhea as provided by the patient, the history that ought to be dwelt on ought to focus on the severity as well as hydration status. The status can be assessed by enquiring on the frequency, quantity, onset, and duration of diarrhea which will give a hint of the amount of loss that the patient has undergone. At the same time, marked weight loss, oral intake and urine output can be given consideration. In consideration of the epidemiological factors, eating history and travel history can be explored.
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Other elements that can be explored include the extra-intestinal causes, for instance, the drugs being taken which may have diarrhea as its side effects, recent surgery or radiations as well as prior episodes of the same condition. The further probing can assist not only in establishing the cause of the disease but also the determination of the probability of the patient developing a complication from the condition.
Physical examinations to be done to the patient
The physical examination is essential in the determination of the source of diarrhea as well as assessing both presence and extent of dehydration. The body should be felt for fever as well as an assessment of stool for blood and mucus. These are inflammatory signs that suggest the presence of invasive bacteria, enteric viruses or cytotoxic organisms. The degree of weight loss can be assessed and related to dehydration and period which diarrhea has occurred.
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Diagnostic tests appropriate for the patient
A sample of the stool can be cultured to determine the organisms that may be responsible for the disease.
Conditions to be considered for differential diagnosis
- Gastroenteritis
- Acute sigmoid diverticulum
- Ischemic bowel
- Infectious colitis
- Incarcerated hernia
- Inflammatory disease
- Omental infarction
…
Ultrasonography can be used to visualize the abdominal organs and the state of the left lower quadrant with the pain. Similarly, computed tomography can also be used to determine the state of various linings of the abdominal organs that might have been impacted. The two radiological tests can indicate inflammation of the affected abdominal area or organ. Due to diarrhea, stool culture and rectal swab can be used to determine the specific causative organisms. These methods are vital in diagnosing the viral gastroenteritis as well as cases of cholera.
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Incarcerated hernia can also be suspected in this case. The condition presents with nausea, vomiting, tenderness at the incarcerated site, inability to empty bowel, sudden pain that quickly intensifies and fever (Yen, Lee & Lam, 2016). This diagnosis can be confirmed via visualization through the imaging tests. In this case, it can be eliminated based on the fact that the patient was able to open bowel as well as the nature of pain which have relatively subsided over the three days.
References
Ahmed, S. M., Hall, A. J., Robinson, A. E., Verhoef, L., Premkumar, P., Parashar, U. D., … &
Lopman, B. A. (2014). Global prevalence of norovirus in cases of gastroenteritis: a
systematic review and meta-analysis. The Lancet infectious diseases, 14(8), 725-730.
Cartwright, S. L., & Knudson, M. P. (2015). Diagnostic imaging of acute abdominal pain in
adults. American family physician, 91(7), 452-459.
Elisei, W., & Tursi, A. (2016). Recent advances in the treatment of colonic diverticular disease
and prevention of acute diverticulitis. Annals of gastroenterology: quarterly publication
of the Hellenic Society of Gastroenterology, 29(1), 24.
Plastaras, L., Vuitton, L., Badet, N., Koch, S., Di Martino, V., & Delabrousse, E. (2015). Acute
colitis: differential diagnosis using multidetector CT. Clinical radiology, 70(3), 262-269.
Yen, C. F., Lee, C. Y., & Lam, H. B. (2016). Incarcerated internal hernia of the broad
ligament. Formosan Journal of Surgery, 49(5), 183-186.
