Chief Complaint: Nausea & Vomiting
History of Present Illness
A 24-year-old woman presents to your urgent care clinic complaining of nausea and vomiting for the past 4 weeks. She had no prior gastrointestinal problems until the onset of symptoms 4 weeks ago. She generally develops nausea about 1/2 hour after eating and then vomits non-bloody material about an hour later. Solid food causes more symptoms than liquids, and the amount of food needed to cause symptoms has been decreasing. Otherwise, she cannot establish any aggravating or alleviating factors. Her weight involuntarily dropped about 3 kg since the onset of symptoms. No close contacts have the same symptoms.
Past Medical/Surgical History
She has not had any abdominal surgery. Her last menstrual period was 2 weeks ago and on schedule. Two years ago, she was honorably discharged from the US Army after injuring her knees while on duty in Afghanistan. Currently she is a sophomore majoring in mechanical engineering at the state university, funded by the GI Bill. She does take over the counter NSAIDs for chronic right knee pain.
Current Meds
NSAIDs OTC
Oral Contraceptives
Social History
The patient does smoke cigarettes recreationally.
Review of Symptoms
No associated postural symptoms, fevers, diaphoresis, headache, neck stiffness, vertigo, chest pain, abdominal pain, or altered mental state.
Physical Examination
Vital signs: 136/72, HR 85, RR 16, Temp 97.9, O2 Sat 98% RA
General: Well-developed and neurologically intact, no distress. Non-toxic
CV: Regular rate and rhythm
Respiratory: Clear A&P and unlabored
Abdomen: Soft, mild epigastric tenderness to palpation. No rebound, guarding or palpable masses.
MS: Moves all extremities, no edema
Skin: Dry without any lesion s or rashes
Case Study Discussion – Part I:
Answer the following and post your response in the Case Study Part I by creating your own initial thread.
Identify three conditions that you would consider in your differential diagnosis, with the most likely condition listed first. Provide rationale for each differential with supporting evidence from the case study.
What further history, further examination, and diagnostic studies should be considered in order to explore your differential diagnosis and confirm your suspicions?
Patient is developing with starting stage of Toxic hepatitis due to prolonged use of NSAIDs for chronic right knee pain due to liver toxicity so there is inflammation of liver..This condition can permanently damage the liver and make scarring of liver tissue ( cirrhosis) causes liver failure..so that only patient having nausea, vomiting, weight loss, loss of appetite..
Dyspepsia is a ulcer formation due to drugs usage make GI upset..
History: she is a having a history of nausea, vomiting and stomach upset,weight loss and using NSAID drug for her pain since 2years
Examination: There is tenderness in the mild epigastric region when palpitating..
Diagnostic studies: Blood test, liver enzyme level, CT and MRI, liver biopsy..
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