A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt “dizzy” and “weak” all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn.

Introduction

Abdominal pain is a common complaint in the Emergency Department (ED), and it can have a wide range of causes. Prompt evaluation and diagnosis are crucial to ensure appropriate management and prevent any potential complications. This case study presents a 52-year-old patient who has arrived in the ED with severe abdominal pain, along with other concerning symptoms.

Clinical Presentation

The patient in question is a 52-year-old male who presented to the ED with complaints of severe abdominal pain, nausea, and vomiting over the last few days. On examination, his abdomen is distended, indicating possible abdominal distension. Additionally, he has poor skin turgor and dry mucous membranes, suggestive of dehydration. The patient also reports not having urinated since yesterday, which raises concerns about possible renal dysfunction or fluid imbalance. Lastly, he mentions feeling “dizzy” and “weak” all evening, which may indicate systemic involvement and potential complications.

Initial Assessment

The initial assessment of this patient should focus on evaluating the severity and etiology of the abdominal pain, determining the patient’s hemodynamic stability, assessing the causes of dehydration and renal dysfunction, and considering other possible etiologies for the patient’s symptoms.

1. Evaluation of abdominal pain: The severity of the abdominal pain should be assessed using a pain scale, such as the Visual Analog Scale (VAS), to gauge the intensity of the pain. Additionally, the location and radiation of the pain, as well as any exacerbating or relieving factors, should be documented. The healthcare provider should also inquire about any associated symptoms, such as nausea, vomiting, or changes in bowel movements, to gain further information about the potential etiology of the pain.

2. Hemodynamic stability: The patient’s vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, should be monitored to assess the patient’s hemodynamic stability. Any signs of hypotension, tachycardia, or hypoxia should prompt immediate action to stabilize the patient’s condition. Intravenous fluid resuscitation may be necessary to manage any fluid imbalances or hypoperfusion.

3. Causes of dehydration and renal dysfunction: Given the patient’s symptoms of poor skin turgor, dry mucous membranes, and decreased urine output, it is important to evaluate the underlying causes of dehydration and renal dysfunction. This may involve ordering laboratory tests, such as blood urea nitrogen (BUN) and creatinine levels, to assess renal function, as well as electrolyte panels to evaluate for any imbalances. Urine specific gravity and osmolarity can also provide further information about the patient’s renal function and hydration status.

4. Consideration of other etiologies: While the patient’s symptoms may initially point towards a gastrointestinal etiology, it is essential to consider other potential causes for the abdominal pain and associated symptoms. This may involve a broader differential diagnosis, including conditions such as pancreatitis, appendicitis, cholecystitis, gastroenteritis, or even conditions outside the gastrointestinal system, such as acute myocardial infarction or diabetic ketoacidosis.

Conclusion

This case presents a 52-year-old patient with severe abdominal pain, along with other concerning symptoms. The initial assessment of this patient should focus on evaluating the severity and etiology of the pain, determining the patient’s hemodynamic stability, assessing the causes of dehydration and renal dysfunction, and considering other possible etiologies for the patient’s symptoms. Timely evaluation and management are crucial to ensure optimal outcomes for the patient.