Upper Abdominal Paine Done By: Ahmed Sami Alwesaibie

For more information, follow me on snap or instagram

@Ahm3dsami

Objectives:

What possible diagnosis can you think of here ?

What must you ask, exam, and test to reach more

conclusive option ?

What laboratory tests are required here ?

What possible diagnosis can you

think of here ?

Our patient symptoms

She was very nauseous at 1st three months

Since a couple of weeks, she develops swollen

ankle

Since a while, she notes right hand numbness

Fundal height was too small ( at the umbilicus +1 )

Pain in her upper right side of abdomen

Finally with seizure

DD\

Most Favorable DD

Digestive disorder

Preeclampsia

Clampsia

HELLP syndrome

Adrenal Insufficiency and Adrenal Crisis

Hint 3rd trimester increase the risk

1st pregnancy increase risk ratio by 2.91

The theory say that may be due to limited exposer to

partner antigen.

Family history “ as the missed point regarding her

sister “ increase the risk ratio by 2.90

Her presentation of Nausea

Ankle swollen which may be edema

Upper abdominal pain

seizure

Eclambsia

What must you ask, exam, and test

to reach more conclusive option ?

history

Physical examination

Investigation

My Aim

Is to exclude other DD

Is to confirm our favorable diagnosis

History

History

After taking a general history especially regarding

our patient case and her symptoms, we can

specified the Q to be regarding our thinking;

At beginning general Q about

Main complain

biographical data

Regarding her sexual life

Regarding menstruation and her period

Her sexual life with her husband

…

Regarding nausea

When it start?

How is it sever?

Persist to how?

Aggravating and relieving factors?

Till when it persist?

Regarding abdominal pain

Since when?

At which site?

How it sever?

Is it referred?

Can you prescribe it?

Frequency of attacks?

Any related or other symptoms?

Aggravating and relieving factors?

Other Q

Regarding the edema and since when it developed?

Regarding any allergy

Any history of drugs use

History of chronic disease

Surgical history

Family history for same condition

Physical

Examination

2 types

General Examination ( from head to toe )

Specific Examination

General Examination

Specific Examination

BP in supine and setting position

Patient weight and how it speed grown

Liver tenderness

Edema in different body parts (face, sacrum,

hands, and ankles)

Funduscopic examination to detect any

vasoconstriction

What laboratory tests are required

here ?

2 types of laboratory tests

Maternal study

Fetus study

Maternal study laboratory tests

CPC

Platelet count

Coagulation profile ( PT, PTT )

Liver function study

Serum creatinine

Uric acid

24-Hour urine

Creatinin clearance

Total urinary protein

Fetal study

Ultrasound examination

Fetal weight and growth

Amniotic fluid volume

Non-stress test or biophysical profile

References

Questions ?

Thank you