Victor Billar, Acute Abdominal Pain

Abstract

Abstract This is an OSCE case. Mr. Victor Billar comes to the walk-in clinic with complaint of acute abdominal pain. The pain started about 4 hours ago, approximately 1 hour after eating a rich, fatty meal. He has had occasional “cramping pain” in the RUQ before, but it had always decreased within an hour or so, and has never been so severe (now the pain is 9–10/10). This time the pain is “steady”, worse with movement, radiating to the right shoulder. The patient feels nauseated, and has vomited once about 1 hr ago. On arrival, patient's VS are: T 101F, BP 140/85 mm Hg; HR 110 bpm, RR 16/min. On physical examination, patient is tender in RUQ and epigastrium, Murphy's sign is (+); McBurney's (−), Rovsing's (−), Aaron's (−), Blumberg (−). Since acute abdominal pain is a common presentation in the setting of emergency medicine, surgery and primary care, it is important for all medical students to exercise in a safe environment (with standardized patients) their skills in clinical examination, history taking and explore possible differential diagnoses. This case has been successfully used for teaching clinical presentation and differential diagnosis of acute abdominal pain for 40 first-year medical students in an integrated curriculum. The students were able to recognize the important clinical signs and include the correct diagnosis in their list of differential considerations.

Keywords

• OSCE
• Abdominal Pain
• Cholecystitis
• Stomach Pain
• Gallstones