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ABDOMINAL PAIN. Dr. Bandar saleh.

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ABDOMINAL PAIN

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Presentation Transcript


ABDOMINAL PAIN

Dr.Bandarsaleh


  • 15 year old female comes to the clinic presenting with a chief complaint of abdominal pain. The abdominal pain is generalized in location, and described as a dull pain, non-radiating. She notes some acid reflex, and reports she has a history of gastritis. She also notes decreased appetite recently. Denies any nausea or vomiting, denies any recent bowel changes.

Present History


  • PastMedicalHistory : no thing

  • PastSymptomsHistory : no thing

  • FamilyHistory:no thing .


  • Denies current sexual activity, denies alcohol use or smoking. LMP was 2 week ago.

  • Physical Exam: Unremarkable except some generalized tenderness in the abdominal region, no rebound, no guarding. Rectal/pelvic exam was deferred.

Social History


  • -Gastritis/GERD

  • -Parasites

  • -Pregnancy

  • -Gastroenteritis

  • -Irritable Bowel Syndrome

Differential Diagnosis


  • There are several parasitology tests that are available at the clinic, but we chose to do a simple microscopic examination (“Parasitologia Simple) as well as an cytologic examination of the fecal mucous (“Moco Fecal”). The microscopic exam simply examines a portion of stool under the microscope to look for any eggs, cysts, or other evidence of parasites. The fecal mucous test is a way to examine the cytology of stool, looking for any evidence of certain cells (e.g. neutrophils, eosinophils, etc.) The fecal mucous test helps to determine if a gastrointestinal infection is of viral or bacterial origin.

  • At least at clinic, there is no availability of testing for GERD (e.g. H. pylori antibodies, breath test, etc.). However, if we truly suspect gastritis/GERD and want to confirm the diagnosis, we can refer the patient to have an endoscopy.

  • Although we do have a urine pregnancy test available at the clinic, we did not order it, mainly based on the patient’s denial of sexual activity and recent menstruation.

Laboratory Test


  • We chose to treat the patient for gastritis/GERD symptoms, and started her on omeprazole (proton pump inhibitor) and metoclopromide (antiemetic and gastroprokinetic). Gastritis/GERD.However, pending her stool results, we would also start her on an antiparasitic, the one commonly used here is tinidazole. The main side effect of tinidazoleis that it can have a disulfiram-like reaction when drinking alcohol.

  • In many cases of abdominal pain, especially abdominal pain in children, physicians will treat the patient with antiparasiticsempirically, as it is such a common problem. Particularly within the patient population ,giardiasis appears to be a common problem.

Treatment Plan


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