Patient: Julia Jackson 6 SLIDES MINIMUM Julia Jackson is an 84-year-old woman who presents to the Emergency room with severe abdominal pain, especially in the left lower quadrant. An abdominal CT was ordered, and it found that there is a 5cm mass in the lower sigmoid colon with fecal impaction. The patient was admitted to the Med/Surg floor for treatment and resolution of fecal impaction. An oncology consult order was entered. The patient stated she has abdominal pain of 8 out of 10.

Title: Evaluating the Management of Abdominal Pain and Fecal Impaction in an Elderly Patient with Colon Mass: A Case Study

Introduction:
Abdominal pain is a common presenting symptom in emergency departments, and it can have various underlying etiologies. This case study examines the management of severe abdominal pain, specifically in the left lower quadrant, in an 84-year-old patient named Julia Jackson. The patient’s presenting symptomology, diagnostic findings, and subsequent treatment will be evaluated, with a particular focus on the presence of a 5cm mass in the lower sigmoid colon with fecal impaction. Additionally, this case study highlights the need for an oncology consult due to the suspected malignancy.

Clinical Presentation:
Julia Jackson, an 84-year-old female, presented to the emergency room complaining of severe abdominal pain, particularly in the left lower quadrant. The intensity of the pain was rated at 8 out of 10. The nature of the pain was not explicitly described, and other associated symptoms were not mentioned. To assess the etiology of her symptoms, an abdominal CT scan was ordered.

Diagnostic Findings:
The abdominal CT scan revealed a 5cm mass in the lower sigmoid colon accompanied by fecal impaction. The precise location of the mass within the sigmoid colon was not specified. The presence of fecal impaction suggests a prolonged obstruction, leading to the accumulation of hardened fecal matter in the colon. Fecal impaction is a potential comorbidity associated with colorectal neoplasms.

Management and Treatment:
Based on the diagnostic findings, Julia Jackson was admitted to the Medical/Surgical floor for the resolution of fecal impaction. The primary goal of treatment is to alleviate the abdominal pain and address the underlying pathology. However, due to the discovery of a colonic mass, an oncology consult was also initiated to assess the potential malignancy.

Pain Management:
As the patient reported severe abdominal pain, an essential aspect of Julia Jackson’s management would involve pain control. Pain can be subjectively measured using a numeric rating scale, with 0 denoting no pain and 10 representing the worst imaginable pain. Julia rated her pain at 8 out of 10, indicating a high level of discomfort. Uncertainties remain regarding the specific intervention implemented to manage her pain; however, pain relief pharmacological or non-pharmacological interventions are likely to have been utilized.

Fecal Impaction Resolution:
The presence of fecal impaction in Julia Jackson necessitates prompt resolution to alleviate symptoms and facilitate colonic function. Fecal impaction can be managed through multiple approaches, such as manual disimpaction, stool softeners, oral or rectal laxatives, and enemas. The most appropriate intervention depends on the severity of impaction, patient factors, and physician preferences. However, specific details regarding the chosen method for fecal impaction resolution were not provided in this case study.

Oncology Consult:
Given the finding of a colonic mass, an oncology consult was ordered to evaluate the potential malignancy. The size of the mass, reported as 5cm, is a significant concern, as larger masses are often associated with a higher likelihood of malignancy. The exact nature of the mass and its histological characteristics are unknown. Further diagnostic investigations, such as a biopsy or additional imaging modalities, may be required to determine the nature and stage of the tumor.

Conclusion:
This case study highlights the clinical management of an elderly patient presenting with severe abdominal pain localized to the left lower quadrant. The identification of a 5cm mass in the lower sigmoid colon accompanied by fecal impaction warrants further investigation, specifically an oncology consult to assess the potential malignancy. The resolution of fecal impaction and pain control are important components of the patient’s management. While the specific treatment interventions are not provided in this case study, various pharmacological and non-pharmacological approaches can be employed in these scenarios. Further research is necessary to understand the optimal management strategies for cases such as Julia Jackson’s, considering the patient’s age and the potential presence of malignancy.