The initial assumption after hearing about the 20-year-old female patient’s nausea and vomiting is that she had suffered from food intolerance because it is a common occurrence when people eat shellfish (LeBlond, Brown, & DeGowin, 2009). However, it is important to remember that misdiagnosis occurs in 30 – 40 percent of cases in which patients report abdominal pain (Seller & Symons, 2012), so a detailed assessment of the patient’s medical history should be performed, followed by physical examinations and diagnostic tests.
Previous or current pharmacological treatments and information about possible chronic disorders is relevant for reaching the correct diagnosis. For example, if the patient suffers from anemia, drug reactions will be a probable cause because iron preparations are associated with chronic nausea and vomiting (Seller & Symons, 2012). Furthermore, several conditions, such as impaired immunologic functions, can affect the diagnostic process (Chen & Mills, 2011).
The physical assessment should begin with the observation of the abdomen to detect abnormal masses, skin conditions, or visible peristalsis (LeBlond, Brown, & DeGowin, 2009). The percussion and palpation begins only after possible skin conditions or irregularities are detected. If the patient displays tenderness over the gallbladder during this part of the examination, it is possible to consider acute cholecystitis as a potential diagnosis.
In this case, food poisoning, food intolerance, gastroenteritis, reactions to drug treatments, viral or bacterial infections, and acute cholecystitis are possible diagnoses. Viral and bacterial infections can be eliminated because they are characterized by high fevers while the patient only experienced a mild fever. I would ask the patient whether she had experienced diarrhea in the past 48 hours. Without the presence of diarrhea, it would be possible to rule out food poisoning, gastroenteritis, and food intolerance (LeBlond et al., 2009).
That would leave drug reactions and acute cholecystitis as possible diagnoses, and the patient will have to take several tests before the final diagnosis is established. A serum drug level measurement should be conducted to identify whether drugs are the causes of her symptoms. Because gastritis can also be drug induced, endoscopy in adjunction with biopsy should be used to identify potential viral agents in the gastrointestinal tract. Finally, the symptoms suggest that acute cholecystitis is the most probable diagnosis, so ultrasonography should be conducted to look for sludge or stones in the lumen of the gallbladder wall while a radionuclide scan can reveal potential obstructions in the cystic duct (LeBlond et al., 2009).
References
Chen, E. H., & Mills, A. M. (2011). Abdominal pain in special populations. Emergency Medicine Clinics of North America, 29(2), 449-458.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin's diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
Seller, R. H., & Symons, A. B. (2012). Differential diagnosis of common complaints (6th ed.). Philadelphia, PA: W. B. Saunders Company.
