This document discusses a case of upper abdominal pain in a pregnant patient. It considers potential diagnoses of preeclampsia, HELLP syndrome, or eclampsia given her symptoms of nausea, ankle swelling, abdominal pain, and seizure. To make a diagnosis, the document recommends taking a thorough medical history, performing a physical exam including blood pressure checks and fundal height measurement, and ordering laboratory tests on the mother including a complete blood count, liver and kidney function tests, and a urinalysis. Fetal testing with ultrasound and non-stress tests are also suggested to evaluate fetal growth and well-being.

1. Upper Abdominal Paine
Done By: Ahmed Sami Alwesaibie
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2. Objectives:
What possible diagnosis can you think of here ?
What must you ask, exam, and test to reach more
conclusive option ?
What laboratory tests are required here ?

3. What possible diagnosis can you
think of here ?

4. Our patient symptoms
 She was very nauseous at 1st three months
Since a couple of weeks, she develops swollen
ankle
Since a while, she notes right hand numbness
Fundal height was too small ( at the umbilicus +1 )
Pain in her upper right side of abdomen
Finally with seizure

5. DD

6. Most Favorable DD
Digestive disorder
Preeclampsia
Clampsia
HELLP syndrome
Adrenal Insufficiency and Adrenal Crisis

7. Hint
3rd trimester increase the risk
1st pregnancy increase risk ratio by 2.91
The theory say that may be due to limited exposer to
partner antigen.
Family history “ as the missed point regarding her
sister “ increase the risk ratio by 2.90
Her presentation of
 Nausea
 Ankle swollen which may be edema
 Upper abdominal pain
 seizure
Eclambsia

8. What must you ask, exam, and test
to reach more conclusive option ?

9. history
Physical
examination
Investigation

10. My Aim
Is to exclude other DD
Is to confirm our favorable diagnosis

11. History

12. History
After taking a general history especially regarding
our patient case and her symptoms, we can
specified the Q to be regarding our thinking;
At beginning general Q about
Main complain
biographical data

13. Regarding her sexual life
Regarding menstruation and her period
Her sexual life with her husband
 …

14. Regarding nausea
When it start?
How is it sever?
Persist to how?
Aggravating and relieving factors?
Till when it persist?

15. Regarding abdominal pain
Since when?
At which site?
How it sever?
Is it referred?
Can you prescribe it?
Frequency of attacks?
Any related or other symptoms?
Aggravating and relieving factors?

16. Other Q
 Regarding the edema and since when it developed?
 Regarding any allergy
 Any history of drugs use
 History of chronic disease
 Surgical history
 Family history for same condition

17. Physical
Examination

18. 2 types
General Examination ( from head to toe )
Specific Examination

19. General Examination

20. Specific Examination
BP in supine and setting position
Patient weight and how it speed grown
Liver tenderness
Edema in different body parts (face, sacrum,
hands, and ankles)
Funduscopic examination to detect any
vasoconstriction

23. What laboratory tests are required
here ?

24. 2 types of laboratory tests
 Maternal study
 Fetus study

25. Maternal study laboratory tests
CPC
Platelet count
Coagulation profile ( PT, PTT )
Liver function study
Serum creatinine
Uric acid
24-Hour urine
Creatinin clearance
Total urinary protein

26. Fetal study
Ultrasound examination
Fetal weight and growth
Amniotic fluid volume
Non-stress test or biophysical profile

27. References

28. Questions ?

29. Thank you