A 54-year-old Latin woman which is in the emergency department, complains of persistent, extreme upper quadrant pain radiating to her right scapula, which lasted nearly six hours

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A 54-year-old Latin woman which is in the emergency department, complains of persistent, extreme upper quadrant pain radiating to her right scapula, which lasted nearly six hours. two She vomited 2 times without pain relief. A few weeks earlier, she had two similar, but less intense, episodes of such pain, where she didn't seek for medical attention. She has no chronic condition. The test shows a fairly obese woman with a temperature of 100.4°F. Her sclerae are mildly icteric. She exhibits abdominal guarding, mild right upper quadrant tenderness on palpation, delay of inspiration during palpation, and regular intestinal sounds. The WBC count is 14,000 cells/mm³ and the alkaline phosphatase rate is increased to 200 IU/L. The overall rate of bilirubin is 4 mg/dL. Her serum aminotransferase values are good values.

What diagnosis for this individual? What kind of imaging study shall we do? How to manage her condition?

 

 

An 80-year-old white male is taken to the hospital by his wife because she is worried for his memory. The only medical problem for the patient is moderate hypertension, treated with hydrochlorothiazide (12.5 mg daily). During the initial clinical consultation, his wife admits that about two years earlier she started to note that he was getting more forgetful and irritable. A former primary school teacher, he's always been a little stubborn, but rising stubbornness is driving his wife's patience. A year earlier, the wife took up the challenge of paying bills after her husband fell behind in this obligation and started to collect late notices. Progressively, his participation and engagement in the hobbies he previously loved diminished. He began to sleep throughout the day and spent lot of time at night. Often she found him in the kitchen, cooking dinner at 4 o clock in the morning. She's been terrified to leave him at home alone. Half year before, he had been involved in a minor motor vehicle crash and had been charged with refusing to take the responsibility, and he refuses to stop driving even though there were a series of close accidents since then. Τhe patient is a tall, well-dressed man with a polite attitude, but with no spontaneity.

BP = 165/80 mmHg

Pulse = 75 beats/min

Respiration = 18 beats/min

Temp = 98.6F

Study results during the medical assessment, including a detailed neurological examination, was common except for bilateral capsule reflexes. He has trouble executing basic instructions. His Folstein MMSE score = 20/30, and he is oblivious of his mistakes. He gets 3/30 on the Geriatric Depression Scale indicating that he isn't depressed. When questioned how everything is at home, he pauses for a moment and replies, everything is okay. When asked about his relationship with his wife, all he mentions is that his wife is a lovely woman. His self-assessment is that he's doing fine for an elderly man. When questioned about his memory, he says it's fine, and he doesn't have trouble recalling pressing matters.

Lab analysis demonstrates good hematocrit and serum creatinine levels. The findings of the liver function test are good. B12 level = 480 pg/mL; folate = 10 ng/mL and TSH = 3 IU/mL. The rapid plasma reagent test (for syphilis) is non-reactive. CT scan of the head acquired at the time of his car crash six months ago, allegedly revealed age-consistent ocerebral atrophy.

 

What is the most important feature of this patient's appearance when constructing a differential diagnosis? What results are most typical of AD or other causes of dementia in the MRI or CT? What is the potentially treatable factor of loss of memory for this person to be screened? Could something be done to support his spouse handle her husband's behavior?