Abdominal Pain Essay

The patient presented with a history of binge intake of Vodka (0. 5 liters) and history of a previous right upper abdominal pain which was self-limiting. Acute pancreatitis develops gradually following alcoholic abuse (Kim et al. The initial occurrence of RUQ pain was possibly an indication of an initial acute pancreatitis which was caused by alcohol due to the patient's history of binge drinking. The continued alcohol consumption increased the gradual damage to the pancreatic cells leading to the development of the second bout of acute pancreatitis which is evidenced by a more enduring RUQ pain which increases in intensity from 2-5 pain scale, vomiting and nausea (Yadav & Lowenfels, 2013). In alcohol intake, the liver breaks down alcohol by an enzyme alcohol dehydrogenase (ADH) which breaks it down to acetaldehyde.

 Aldehyde dehydrogenase (ALDH) then breaks it down into acetate, which is further broken down into carbon dioxide and water. This process leads to the death of liver cells which are however replaced. In heavy alcohol intake, the rate of regeneration of the liver is lowered and this predisposes the patients to develop liver disease. The initial stage in alcohol liver disease is the alcoholic fatty disease which is due to accumulation of fats in the liver. The patient's social history indicates that she had been in a monogamous relationship and history of smoking Marijuana which increases her risk of ectopic pregnancy (Friedrich, Khatib, Parsa, Santopietro & Gallicano, 2016). The presumptive diagnosis of ectopic pregnancy is indicated by the patient’s history of presenting illness where she presents with abdominal pain.

Ectopic pregnancy can present with among others, abdominal pain, amenorrhea, vaginal bleeding (Yıldırım, Cırık, Altay & Gelisen, 2014). The patient history of smoking marijuana also presents a risk factor for the occurrence of ectopic pregnancy. Smoking has been linked with increasing the risk of developing ectopic pregnancy in women of reproductive age (Yıldırım, Cırık, Altay & Gelisen, 2014). Additional information on the review of the system can be obtained on the presence of hypotension, fever or tachycardia which occurs often in acute pancreatitis, the presence of jaundice which may be an occurrence observed in acute pancreatitis. A comprehensive review of the patient's gastrointestinal system, respiratory and circulatory system is imperative to identify any reports symptoms of hemodynamic instability, hematemesis or melena and respiratory distress that may occur in acute pancreatitis (Yadav & Lowenfels, 2013).

The positives expected for the patient diagnosis would be a sudden onset of pain located in the upper abdomen radiating to the back with a steady increase in severity. The pain ought to relieve by sitting up bending forward and lasting for about a day (Yadav & Lowenfels, 2013). The sudden onset of the pain differentiates the diagnosis of hepatic alcoholic disease whose onset is gradual and symptoms occur gradually with the gradual damage to the liver. Observation may or may not indicate jaundice in the patient which rules out alcoholic hepatitis which is characterized by an onset of jaundice. Laboratory Tests The working diagnosis of acute pancreatitis can then be confirmed using laboratory work up to support the clinical impression of the condition, confirm the etiology and any complications.

Laboratory assessment of serum lipase and amylase is critical in the diagnosis of acute pancreatitis. The laboratory assessment of serum lipase and amylase is important as in acute pancreatitis is associated with elevated levels of the enzymes up to three times the optimum levels (Basnayake & Ratnam, 2015). Amylase P (produced by the pancreases) is a more specific measure for acute pancreatitis (Basnayake & Ratnam, 2015). Laboratory electrolyte tests are imperative in guiding management due to the patient’s history of vomiting. Soap Note [S]: 26-year-old female reports to the clinic with a chief complaint of right upper abdominal pain, nausea, vomiting and anorexia. [O] general: hypotensive, febrile with tachycardia and dyspneic. The patient looks sickly and in pain with a pain threshold of 5 on the pain scale.

Neck: No observable abnormalities, no jugular distension or carotid bruits on auscultation, on palpation no masses, no lymphadenopathy. , Alliu, S. , & Akinjero, A. et al. Cannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease.  Liver International. , & Petrov, M. Factors That Affect Risk for Pancreatic Disease in the General Population: A Systematic Review and Meta-analysis of Prospective Cohort Studies.  Clinical Gastroenterology and Hepatology, 12(10), 1635-1644. e5. doi: 10. , Parsa, K. , Santopietro, A. , & Gallicano, G. The grass isn’t always greener: The effects of cannabis on embryological development.  BMC Pharmacology and Toxicology, 17(1). 1016/s0016-5085(18)32523-x Masamune, A. Alcohol Misuse and Pancreatitis: A Lesson from Meta-Analysis.  Ebiomedicine, 2(12), 1860-1861. doi: 10. 1016/j. , Rehm, J. , & Roerecke, M. Alcohol Consumption as a Risk Factor for Acute and Chronic Pancreatitis: A Systematic Review and a Series of Meta-analyses.