common complaints of patients presenting to emergency departments

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Abdominal pain is one of the most common complaints of patients presenting to emergency departments, accounting for approximately 4–5% often due to primary care referrals (Vaghef-Davari et al, 2019). A thorough patient history and examination is the foundation of determining the proper diagnosis. Ordering numerous costly tests is not ideal therefor strong examination skills and a complete history will assist in directing potential diagnosis such as those listed below. In this case study possible patient diagnosis based on symptoms, presentation and history can include GERD, Gastritis, peptic ulcer, acute pancreatitis, angina, and even abdominal aortic aneurysm. Diagnostic Considerations for this patient are 1). Gastritis: The patient exceeds the recommended drinking level for men of less than 14 drinks a week and less than 4 drinks on any one occasion. Patient has heart rate of 110, suggesting possible withdrawal and possibly dehydration. (2). Peptic ulcer: the patient has pain radiating to the back, seen in posterior penetrating ulcers. Alcohol intake is a risk factor. (3). Acute pancreatitis. The patient’s alcohol intake is a risk factor, and his temperature is slightly elevated. The pain is persisting and radiates to the back, but the location of the pain is not typical. However, left upper quadrant pain is more typical in pancreatitis, and typically more severe in nature. (4). GERD: The patient has a history of alcohol use which can cause relaxation of the lower esophageal sphincter pressure, leading to symptoms of reflux. He has nausea and epigastric tenderness, which can be present in GERD. However, the lack of heartburn, a burning sensation in the retrosternal area particularly in the post prandial period, coupled with the absence of dysphagia and  regurgitation, make this diagnosis less likely according to the text (Bickley et al, 2021). (5). Angina: The patient has cardiac risk factors of age, smoking, hypertension, and high alcohol intake. Patient reports burning pain in the chest.

Diagnostic Work up:

EKG to rule out immediate cardiac event.

Thorough blood work: CBC, CMP, H&H, LFT’s, troponin

Serum alcohol level and urine toxicology due excessive alcohol use

Ultrasound or CT of upper abdomen

Endoscopy (EGD) with mucosal biopsy is one of the most accurate tests to detect

presence of mucosal irritation (gastritis) or the presence of a peptic ulcer.

Trial of antacids for 4-6 weeks, if no improvement referral for an endoscopy.

Patient counseling/education on alcohol abuse

Echocardiogram to further rule out cardiac related pathophysiology.

This patient is most likely to have alcohol?induced gastropathy; however, peptic ulcer disease cannot be

excluded. An endoscopy would differentiate these two entities. It also includes acute pancreatitis, GERD,

and angina (Bickley et al, 2021).

References:

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and history taking. Wolter Kluwer.

Vaghef-Davari, F., Ahmadi-Amoli, H., Sharifi, A., Teymouri, F., & Paprouschi, N. (2019) Approach to acute abdominal Ppain: Practical algorithms. Adv J Emerg Med. doi: 10.22114/ajem.v0i0.272.

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