HPB case study

Patient Case Study
Mr Bob Jackson is a 55 year old man admitted to ED with a presenting complaint of
diarrhoea, nausea and malaise. His Subjective and Objective examinations are as follows:
History of presenting complaint:
1 week history of increasing Left Lower Quadrant (LLQ) abdominal pain and diarrhoea
Medical History:
• Obesity
• Osteoarthritis Right knee
• Hypertension
• Seasonal rhinitis
• Depression
• AF
Surgical History:
• Appendicectomy as a child
• Knee arthroscopy 2005
Allergies
• NKA
Medications
• Celebrex
• Ramipril
• Metoprolol
Review of Systems
CNS
• Currently not on antidepressants, describes normal mood in last year
• No dizziness, headache, vision change noted, except some headache during last few days
Resp
• Recurrent bronchitis and colds over last year
• CXR NAD 12 months ago
• Recent haemoptysis and persistent cough with mild pleuritic pain over 1/12
CVS
• Regular antihypertensives (Ramipril)
• No central chest pain/ palpitations/dizziness reported
GIT
• 3/12 Hx of occasional loose stools and frank blood in bowl.
• States that over the years that he has often had runs of watery diarrhoea that he treats with
‘gastro-stop’
• States a history of ‘piles’
UGS
• No retention/hesitancy/pain
MKS
• Nocturnal bone pain in hips and back noted last 2/12 – treated with OTC Ibuprofen
• Hx of knee and lumbar pain
Social History
• Sheep farmer at Patersons Plains, a rural community 100 km Northwest of Melbourne. Married
with 2 adult children.
Lifestyle
• Currently smokes – pack a day for the last 35 years
• Alcohol: 6 stubbies of heavy beer a week
• Denies illicit drug use
On examination:
Vital signs: T-37, HR -96 Sinus Rhythm, RR 20, BP 165/110, SpO2 98% on RA
CNS
• Alert and orientated
Resp
• Chest clear on auscultation
CVS
• Warm and well perfused, cap refill < 3 sec, slight pallor
GIT
• Pain Left lower Quadrant
• 6/10 at rest ↑8/10 on movement
• Mildly obese
• abdo soft and tender in LLQ
• Lower abdominal distension noted
UGS
• Urinalysis shows SG 1.05, otherwise NAD
MKS
• NAD
Assignment question
Answer the following questions in regards to Mr Jackson’s presentation.
1. Hypothesise the most likely chronic disease process that fits Mr Jackson’s symptoms and
history. Your hypothesis must be justified by aetiology and pathophysiology relevant to Mr
Jackson’s presentation.
2. Name one other chronic disease that explains Mr Jackson’s symptoms. Justify what
further data, such as diagnostic tests and/or further history, which would enable a clinician
to discriminate between these two diseases.
Guidelines
Part 1 is asking you to find the most likely disease that fits these symptoms – not
the most obscure disease to fit these symptoms. There are many diseases that fit but
select one that is most likely i.e. fits the symptoms but also is common.
Marks in this assignment are not attained for regurgitating facts – you must use
the facts (aetiology and pathophysiology) to justify your proposed disease – that is,
how well does the proposed aetiology and pathophysiology fit the symptom profile,
how realistic is it, why do you think that this is the most likely disease? It might be
useful to look at epidemiology and the risk factors that increase the chances of one
disease being more likely than another
Read the rubric – half the marks are for analysis and the rest split evenly between
logical construction and use of evidence. This assignment is heavily weighted
towards how you use your facts and how you structure your argument – there are no
marks for piling facts up randomly.
The marker do not have a list of diseases that you must satisfy to get marks. If you
justify your selected physiology with a rational argument as to its likelihood you will
have marks accorded.
The first sentence in part 2 is a statement. You do not need to provide a rationale
at this stage.
In the rest of part 2 you will need to provide examples of diagnostic tests and/or
further information from Mr Jackson that the collaborative care team might employ
to differentiate between the two diseases that you have selected. It might be
appropriate to compare and contrast the two pathophysiologies at this point.
How many references do you need? If you use three or less, then you are in
danger of having a very restricted information base to make an effective argument.
Assignment Instructions
Format:
• The assignment will be read on-screen by markers so use a web-friendly font and
spacing: Use–Georgia, Arial or Verdana size 12 font with 1.15-1.5 spacing.
• Dot point format not acceptable
• References used should be acknowledged in-text using APA version 6 formatting
• Provide a full list of end-text references using APA Version 6 formatting.
Construction:
• No introduction or conclusion required
• Use headings for Part 1 and part 2 to partition the assignment but do not use the
assignment questions in the heading.
• The discussion must be presented using academic assignment format with
attention to good paragraph structure, grammar, Australian spelling and formal
academic expression.