Differential Diagnosis Further History Taking
The encounter of a patient with back pain radiating to the back, the groin and stomach calls for a further history taking to shed more light on the condition. I will inquire about how the pain feels concerning whether it is a sharp or even dull pain. I will ask the patient whether he took any medication to alleviate the p[ain. I will also assess whether there are factors that aggravate or relieve the pain including a change in position. I will also inquire whether food affects the pain and any history of a previous abdominal surgery. I will also ask the patient about his hygiene habits and the color of the urine which may indicate a urinary tract infection. I will also take an history of the client’s diet since it is a predisposing factor in the formation of renal stones.
Differential Diagnosis
N20.9 Urinary Calculus,unspecified
Urinary calculus is also referred to as urolithiasis and this is what the patient might be suffering from. The main cause of renal stones is calcium deposits mainly derived from food. The intake of foods with a high salt concentration predispose a person to renal calculi due to the inability of the kidneys to flush out all the salts. Some of the wastes accumulate within the urinary system in the form of stones and may cause blockage (Baggaet al, 2013). The disease is characterized by nausea, vomiting, back pain and fever and chills due to a secondary infection.
K82.9 Disease of Gallbladder, Unspecified
I will suspect that the patient is suffering from gallbladder disease and particularly cholecystitis. Cholecystitis is the inflammation of the gallbladder as a result of irritation mainly due to the gallstones which block the biliary ducts. Bile builds up in the gallbladder since it cannot be secreted into the small intestines (Baron, Grimm & Swanstrom, 2015). Pain in acute cholecystitis occurs in the upper right side or the top middle part of the abdomen especially right after a meal and may be accompanied by fever, nausea, vomiting, and jaundice.
K85.9 Acute Pancreatitis, Unspecified
It is the inflammation of the pancreas due to the irritation of the origin by the digestive enzymes. It is mostly caused by gallstones and excessive alcohol consumption. Digestive enzymes are activated before they reach the small intestines making them digest the pancreas (Banks et al, 2013). The disease is characterized by abdominal pain which radiates to the back aggravated by taking a meal, a swollen and tender abdomen, fever and nausea and vomiting.
N39.0 Urinary Tract Infection, Site Not Specified
A urinary tract infection affects either the bladder or the urethra and is characterized by an increased urge to urinate, pain with urination, back and groin pain (Foxman, 2014). An individual with a urinary tract infection presents with lower back pain, malaise, fever and chills and sometimes nausea.
Physical Examination and Further Tests
I will perform an abdominal examination on the patient to examine tenderness and rule out any swelling. I will also check for Murphy’s sign which is a suggestive indicator for gallbladder infection. I will order an X-ray of the abdomen to check for the presence of gallstones. I will order for an ultrasound to visualize the abdominal organs including the pancreas and gallbladder to rule out infection (Baron, Grimm & Swanstrom, 2015). An HIDA can also be done to scan to diagnose gallbladder disease through visualizing all the ducts in the gallbladder and the liver.
I will order pancreatic function tests to determine the level of digestive enzymes produced by the pancreas. I will also measure the blood levels of amylase, lipase in conjunction with a glucose tolerance test. A biopsy can also be done to isolate the causative organism of the infection through tissue culture. I will perform a urinalysis test to visualize the color of the urine and also determine the presence of microorganisms which are indicative of a urinary tract infection. The color, smell, and appearance of urine together with other microscopic elements of urine provide information on whether there is a urinary tract infection (Foxman, 2014). The presence of blood cells including white blood cells and red blood cells are suggestive of an infection of the urinary tract.
References
Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G., … & Vege, S. S. (2013). Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut, 62(1), 102-111.
Bagga, H. S., Chi, T., Miller, J., & Stoller, M. L. (2013). New insights into the pathogenesis of renal calculi. The Urologic clinics of North America, 40(1), 1.
Baron, T. H., Grimm, I. S., & Swanstrom, L. L. (2015). Interventional approaches to gallbladder disease. New England Journal of Medicine, 373(4), 357-365.
Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious disease clinics of North America, 28(1), 1-13.
