Evita Alonso iHuman | assignmenthandlers

Evita Alonso iHuman

Chief Complaint: “My stomach has been hurting really bad over the past 2 weeks.”

History of Present Illness:

Mrs. Alfonso is a 48-year-old female patient who present to the urgent-care clinic with a two-week history of intermittent, and progressive RUQ pain that has now increase over the past 2 days. The pain radiates to the right shoulder. She also complains of associated symptoms like nausea, vomiting, anorexia since the past 2 days. She has had previous recurrent self-resolving symptoms over the last one year. Family history is positive for biliary disease (mother) Evita Alonso iHuman. The patient is found to have low-grade temp elevation, mild scleral icterus, RUQ abdominal tenderness with guarding, and a positive Murphy’s sign

Onset: 2 weeks ago, with symptoms becoming more dreadful 2 days ago

Location: Right upper quadrant and occasionally radiated to the right shoulder Duration: Pain has been constant since it started this time; in the past it only lasted 1-2 days.

Character: Crampy, gnawing, achiness

Aggravating/alleviating factors: Pain gets worse with meals and unresolved with antacids and NSAIDs Related symptoms: Nausea. Vomiting, anorexia with onset of symptoms 2 days ago. Denies any recent exposure to other ill contacts. She has had similar symptoms previously

Treatments: Has tried OTC antacids and ibuprofen without relief

Significance: Pain starts with a scale of 2-3 and gets up to 6-7. She reports pain has kept her home from work Evita Alonso iHuman.


Primary Diagnosis

Ascending Cholangitis

This diagnosis may be acute or chronic. The gallbladder is a small organ that is a part of your gastrointestinal system which stores and excretes bile to help the body break down fat. Gallstones can form and clog the organ. In your case the gallstones have caused symptoms such as abdominal pain, right shoulder pain, nausea, and vomiting. You need to be admitted to the hospital because according to the tests we ran you may have a clogged duct leading to inflammation and infection. This is not a disease process that is typically treated as an outpatient. You may require surgery or additional testing such as an MRCP to look at the ducts. The surgery which may be needed is called a cholecystectomy. It is a very common procedure performed and is often done laparoscopically and can sometimes be performed as an outpatient procedure. The procedure itself does have some risks since anesthesia is required, but after the gallbladder is removed there will be no return of gallstones. You have an increased risk of forming gallstones when you are overweight (Crowley & Martin, 2022).

The diagnosis for Pt is ascending cholangitis. It is characterised by jaundice, abdominal pai, and fever that develops due to infection and stasis in the biliary tract. Fever, chills, malaise, rigors, widespread abdominal discomfort, pruritus, and pale stools are among the ascending cholangitis symptoms (Chatterjee, Mavani, & Bhatttacharyya, 2022). The Pt reported vomiting nausea, stomach pain, and anorexia. The Pt has a family history of biliary disease and ascending cholangitis develops as a result of biliary tract infection. The family history is a risk factor for developing ascending cholangitis.

Alternative Diagnosis


Cholecystitis is an alternative diagnosis. Stones that obstruct the tube connecting the gallbladder to the small intestine can cause cholecystitis. Bloating and excruciating upper-right abdominal pain are symptoms for cholecystitis. The Pt reported pain that radiate at the right at the right shoulder meaning he can be suffering from cholecystitis. Other symptoms for cholesystitis reported by the Pt include nausea, fever, vomiting, and tenderness over the abdomen, pain spreading to the right shoulder or back, and sever pain at the abdomen (Chatterjee et al., 2022),

Pancreatitis Acute

Another possible diagnosis is pancreatitis acute.  It is a condition that leading to inflammation and enlargement of pancreas for a short time. The systems of pancreatitis acute include nausea, vomiting, fever, abdomen tenderness, abdominal pain radiating to the back, and rapid pulse. The symptoms reported by the Pt resemble most of the pancreatitis acute disorder symptoms.

Peptic Ulcer Disease

The last alternative diagnosis is peptic ulcers. It develops when acid digestive tract acid eats ways to the small intestine or stomach’s inner surface. The symptoms for peptic ulcers include burning stomach pain, heartburn, nausea, bloating and heartburn (Hatnoorkar & Rajpal, 2022) Evita Alonso iHuman. Since the patient reported stomach pain, nausea, and vomiting is possible to consider peptic ulcers as a possible diagnosis.


Case: Management Plan:

Pharmacologic Care:

  • Start IV
  • Collect blood culture x2
  • Give Ertapenem 1g IV
  • Consult general Surgery for the next steps


Supportive Care:

Make NPO

Give 0.9% IV normal Saline 100ml bolus, then 50 ml per hours

Give Zosyn 3.375 g IV every 6 hours for 7 days

Zofran 4mg IV every 6 hours as needed for nausea/vomiting.

Check blood glucose every 4 hours to monitor for hypoglycemia due to NPO status.


Patient Education

  • Offered education on diagnosis, need for continued evaluation in the emergency department given fever and anticipated course. Patient expressed understanding and had no further questions.


  • Alert staff if has increased pain, nausea, fever, lightheadedness, fatigue, or any other needs while in the emergency department.
  • Follow up in clinic post-Op 1-2 weeks after discharge. If gallbladder is removed, decrease fat in diet and eat small meals. Avoid any strenuous activities or lifting. Take pain medication as prescribed.
  • Contact a physician if pain is not adequately controlled. If you have symptoms of infection such as fever/chills or bleeding contact the urgent care as soon as possible Evita Alonso iHuman.


Chatterjee, S., Mavani, A., & Bhatttacharyya, J. (2022). Chemistry and mechanism of the

diseases caused by digestive disorders. In Nutrition and Functional Foods in Boosting

Digestion, Metabolism, and Immune Health (pp. 3-14). Academic Press.


Crowley, K., & Martin, K. A. (2022). Patient education: Gallstones (The Basics). UpToDate.


%20diagnosis&topicRef=666&source=related link


Hatnoorkar, S. A., & Rajpal, C. (2022). Homoeopathy and Acid Peptic Disorder. Journal of

Medical and Pharmaceutical Innovation, 9(45).





Criteria Ratings Pts

10 to >6.0 pts


Clearly written HPI statement with comprehensive information gathering from case questions. Includes important personal /family medical and social history.

6 to >3.0 pts


Well written HPI statement but may be missing 1-2 key components from the history. Missing pertinent positives and negatives. Does not include all important personal /family medical and social history.

3 to >0 pts


Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills. Missing pertinent positives and negatives. Missing important personal /family medical and social history.

10 pts

Management Plan

20 to >14.0 pts


Clearly written plan covering all critical components for patient’s final diagnosis. Follows current quarter management plan template. 3 scholarly references included Evita Alonso iHuman.

14 to >6.0 pts


Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis. Follows some of the current quarter management plan template. 2 scholarly references included.

6 to >0 pts


Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis. Does not follow current quarter management plan template. 0-1 scholarly references included.

20 pts

Performance overview/total i-Human Score

70 to >50.0 pts


Total i-Human performance score is missing 1-2 key elements in overall clinical work-up. History, physical exams, body system classification, differentials, rankings, tests, diagnosis and exercises.

50 to >30.0 pts


Total i-Human performance score is missing some key elements in overall clinical work-up. History, physical exams, body system classification, differentials, rankings, tests, diagnosis and exercises.

30 to >0 pts


Total i-Human performance score is missing many key elements in overall clinical work-up. History, physical exams, body system classification, differentials, rankings, tests, diagnosis and exercises.

70 pts

Total Points: 100 Evita Alonso iHuman

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