From the Research
For a 56-year-old patient with three days of left upper quadrant abdominal pain, the first assessment should be a thorough history and physical examination focused on the abdomen, including vital signs, palpation of all abdominal quadrants, and assessment for rebound tenderness, as recommended by the most recent study 1. This assessment should cover pain characteristics, associated symptoms, and relevant medical history, including previous abdominal surgeries, diverticulitis, inflammatory bowel disease, or kidney stones. Some key points to consider in the history and physical examination include:
- Pain characteristics (onset, quality, radiation, severity, timing)
- Associated symptoms (nausea, vomiting, changes in bowel habits, urinary symptoms)
- Relevant medical history (previous abdominal surgeries, diverticulitis, inflammatory bowel disease, or kidney stones) Laboratory tests should be ordered, including:
- Complete blood count to check for leukocytosis
- Comprehensive metabolic panel
- Urinalysis
- Lipase levels Imaging studies would typically begin with an abdominal CT scan with contrast, which is particularly useful for diagnosing common left-sided abdominal conditions like diverticulitis, kidney stones, or splenic issues, as suggested by 2 and 1. It is essential to consider the patient's age and the potential for atypical presentations of diseases, as noted in 3, and to be aware of the possibility of missed diagnoses, as discussed in 1. By following this approach, the healthcare provider can ensure a comprehensive initial assessment, proper diagnosis, and guided further management, ultimately prioritizing the patient's morbidity, mortality, and quality of life.