The given case presents the information on a woman who is 33 years old. As it follows from the interview and examination, the woman does not use tobacco, alcohol, and illegal drugs. Nevertheless, the patient uses anti-fertility agents regularly. Among the chief complaints that have become the reason to visit the healthcare provider, there is a pain above the pelvis and below the ribs, the pain is localized on the right side of the body. The sensations of pain started approximately two days ago. Importantly, the patient reports the strongest pain sensations under the twelfth rib on the right side; the pain does not shoot up other parts of the body. The sensations of pain have not changed since the occurrence of the problem. As for other chief complaints indicated by the patient, the woman also reports fever and increased body temperature. Importantly, the patient confirms that she has symptoms related to GIT; a day before consulting a healthcare professional, the woman had a few waves of vomiting and nausea. The presence of other symptoms such as alvine flux, colonic stasis, and difficulties during urination and defecation has not been confirmed, the issues related to HEENT have not been detected.
During the interview, the patient answered ten questions concerning her present physical condition, she indicated the localization of pain, its character, the medications taken, and the presence of fever.
The components of the physical exam which need to be given special consideration to in the discussed case are the absence of heart rhythm problems, the absence of large liver mass and splenomegaly which minimizes the possibility of cholecystitis (Zhang, Tan, & Jia, 2017). To exclude the ectopic pregnancy which may require immediate surgical intervention, it is extremely important to ensure that there are no bloody vaginal discharge, breast augmentation, and lower abdominal pain (Crochet, Bastian, & Chireau, 2013). Another important component is the location of pain which helps to identify the affected organs to make the diagnosis.
According to the results of physical examination, the patient has no HEENT issues and cardiac performance problems, and it excludes the possibility of myocardial infarction which is also characterized by the pain under the ribs (Lu, Liu, Sun, Zheng, & Zhang, 2015). More than that, an important finding is the absence of splenomegaly and large liver mass that may point to the low possibility of infectious diseases such as typhoid fever or different parasitic infections (Non, Patel, Esmaeeli, & Despotovic, 2015). The positive exam findings which are important for the case include the localization of the pain under the right twelfth rib that points at the problems related to performance of the right kidney or gall sac – thus, the possible diagnoses include cholecystitis, pancreatitis, and pyelonephritis (Jorge, Keswani, Veerappan, Soper, & Gawron, 2015).
The differential diagnosis to be considered includes ectopic pregnancy (the test needed is the US of the inner reproductive structures) and cholecystitis (urine analysis, biochemical analysis of blood) (Yokoe et al., 2013). More than that, it includes pancreatitis (urine analysis, US, endoscopy), nephrolithiasis (blood analysis, urine culture analysis) (Phillip, Steiner, & AlgĂĽl, 2014). Acute pyelonephritis presents the most probable diagnosis, further tests to identify it include palpation, US of kidneys, and excretory urography.
The final diagnosis that has been defined is acute pyelonephritis. In fact, as is clear from the answers of the patient, there is a range of factors that point at this very condition. In particular, they include increased body temperature, constant flank pain, manifestations of intoxication such as vomiting and nausea.
References
Crochet, J. R., Bastian, L. A., & Chireau, M. V. (2013). Does this woman have an ectopic pregnancy? The rational clinical examination systematic review. Jama, 309(16), 1722-1729.
Jorge, A. M., Keswani, R. N., Veerappan, A., Soper, N. J., & Gawron, A. J. (2015). Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. Journal of Gastrointestinal Surgery, 19(4), 598-603.
Lu, L., Liu, M., Sun, R., Zheng, Y., & Zhang, P. (2015). Myocardial infarction: Symptoms and treatments. Cell Biochemistry and Biophysics, 72(3), 865-867.
Non, L. R., Patel, R., Esmaeeli, A., & Despotovic, V. (2015). Typhoid fever complicated by hemophagocytic lymphohistiocytosis and rhabdomyolysis. The American Journal of Tropical Medicine and Hygiene, 93(5), 1068-1069.
Phillip, V., Steiner, J. M., & AlgĂĽl, H. (2014). Early phase of acute pancreatitis: Assessment and management. World Journal of Gastrointestinal Pathophysiology, 5(3), 158.
Yokoe, M., Takada, T., Strasberg, S. M., Solomkin, J. S., Mayumi, T., Gomi, H.,… Gabata, T. (2013). TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of Hepato-Biliary-Pancreatic Sciences, 20(1), 35-46.
Zhang, R., Tan, J., & Jia, Q. (2017). An unusual case of pain in the gallbladder area: Is it acute cholecystitis? Clinical Gastroenterology and Hepatology, 15(5), e97-e98.