Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Resource Center
Testimonials
Share this Case Study
Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What causes constant upper abdominal pain that worsens after eating?
Could alcohol consumption impact abdominal pain?
Is nausea without vomiting a significant symptom?
How does managing diabetes affect abdominal symptoms?
Could depression influence abdominal pain?
What diagnostic tests are necessary for abdominal pain?
What are the next steps after an initial diagnosis of abdominal issues?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hello, it's nice to meet you. I've heard that you're experiencing some discomfort in your upper abdomen. Could you tell me more about that?
Patient
Hi, yes. I've been having this pain in my upper stomach area for about a week now.
Cody, the AI Doctor
I see. Could you describe the nature of this pain? Has it been constant, or does it come and go?
Patient
It's pretty much constant, but it definitely gets worse after I eat or drink something.
Cody, the AI Doctor
Does anything make the pain better or worse, like changing your position or resting?
Patient
Movement tends to make it worse, so I find myself trying to stay still. Rest helps a bit, but the pain never really goes away entirely.
Cody, the AI Doctor
How about other symptoms? Do you feel nauseous, or have you experienced vomiting or changes in your bowel movements?
Patient
I've been feeling nauseous, but I haven't actually thrown up. And my bowel movements are normal—no diarrhea or anything like that.
Cody, the AI Doctor
Alright. You mentioned this has been happening for about a week. Did the symptoms start suddenly, or did they gradually get worse?
Patient
They started gradually but have definitely gotten worse over the past few days.
Cody, the AI Doctor
Have you noticed any changes in your temperature, like fever, during this time?
Patient
I feel like I might have had a low-grade fever, though I haven't actually measured it.
Cody, the AI Doctor
Understood. Now, let's discuss any past medical history. Do you have any existing medical conditions?
Patient
Yes, I have diabetes, but I've been managing it with my diet. I also deal with depression.
Cody, the AI Doctor
Are you currently taking any medications for these conditions or anything else?
Patient
No, I’m not on any medications right now.
Cody, the AI Doctor
I noticed you didn't mention alcohol use earlier. Do you drink, and if so, how much?
Patient
I usually have a glass or two of beer or wine during the week, but I do drink more on the weekends.
Cody, the AI Doctor
Got it. And just to confirm, have you ever experienced anything like this before?
Patient
No, this is a first for me.
Cody's AI Summary
- You're a 42-year-old man experiencing upper abdominal pain for about a week.
- The pain is constant and worsens after eating or drinking.
- It also radiates to your back, is worsened by movement, and improves with rest.
- You feel nauseous but haven’t vomited, and there's no diarrhea or changes in your bowel movements.
- You suspect a low-grade fever.
- You manage diet-controlled diabetes and depression, and haven't been taking any medications. You drink alcohol socially and more heavily on weekends.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Acute Pancreatitis(50 % probability)
The characteristic constant upper abdominal pain radiating to the back suggests acute pancreatitis, particularly when exacerbated by eating. Your significant alcohol consumption increases the risk, and additional symptoms like nausea support this diagnosis. Further confirmatory lab tests and imaging are needed for definitive diagnosis.
2. Peptic Ulcer Disease(30 % probability)
The intermittent worsening of pain after meals is a typical symptom of peptic ulcer disease. While the lack of vomiting blood or melena reduces its likelihood but does not entirely rule it out, given variations in ulcer presentations. Stress related to managing depression could also be a contributing factor. Further clinical evaluation and perhaps a gastroscopy might provide more insight.
3. Cholecystitis(20 % probability)
Although the pain is not localized to the typical right upper abdominal quadrant, the symptom of pain after eating and accompanying nausea may suggest gallbladder issues. Previous unreported cholecystitis episodes and lack of typical pain localization decrease its probability, but imaging studies are essential to rule this out.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
After analyzing the patient's symptoms and history, the differential diagnosis points towards several gastrointestinal conditions. Each possibility needs thorough consideration and potentially different investigative approaches to verify the actual cause:
1. Acute Pancreatitis(60% probability)
The hallmark symptoms of constant upper abdominal pain radiating to the back, worsened by eating, combined with significant alcohol consumption, strongly support acute pancreatitis. Additional investigations such as serum amylase and lipase, along with imaging, would be crucial for diagnosis confirmation.
2. Peptic Ulcer Disease(20% probability)
While the intermittent worsening of pain post meals could indicate peptic ulcer disease, the lack of severe gastrointestinal bleeding symptoms reduces its likelihood. Stress factors from managing diabetes and depression could play a role, and an endoscopy could provide clearer insights here.
3. Cholecystitis(15% probability)
Although gallbladder issues typically localize pain in the right upper quadrant, the noted eating-induced pain and nausea necessitate consideration. However, it's less consistent with the patient's overall symptom profile, with imaging studies needed to rule this out.
The plan is to prioritize diagnostics focusing on pancreatic function tests and imaging studies initially. Symptomatic management for pain and nausea should be immediately instituted. Advice on alcohol cessation is paramount to mitigate potential exacerbation of the symptoms or development of complications.
Next Steps for Evaluation
Diagnostic Testing:
Laboratory Tests: Initial testing should include serum amylase and lipase levels to evaluate pancreatic inflammation, which would support acute pancreatitis as a primary diagnosis. Triglycerides should be measured since high triglycerides can trigger acute pancreatitis.
Imaging Studies: An abdominal ultrasound is recommended to assess the gallbladder and pancreas, rule out cholecystitis, and evaluate for structural abnormalities. If ambiguity persists, a CT scan of the abdomen could provide additional details.
Clinical Monitoring: Close monitoring of the patient's vital signs and symptoms, particularly pain and nausea, will aid in assessing any progression or changes in condition that might necessitate further diagnostic measures.
Potential Treatment Modalities
Medical Management:
Pain and Symptom Relief: Prescribe analgesics, such as acetaminophen, or antiemetics for nausea under careful monitoring to avoid potential complications.
Pancreatic Enzyme Supplements: If pancreatitis is confirmed, enzyme supplements might be suggested to assist digestion.
Lifestyle Modifications:
Dietary Adjustments: Immediate shift to a light, low-fat diet to ease pancreatic workload and minimize symptoms.
Alcohol Cessation: Abstain from alcohol entirely to prevent exacerbation of symptoms and reduce the risk of recurrence or complications.
Hospital Admission: In cases of acute pancreatitis confirmation, hospitalization may be necessary for intravenous hydration, pain management, and further investigations.
Surgical Options: Though not immediately indicated, should gallbladder disease be confirmed, surgical intervention like cholecystectomy might be considered.
Conclusion
A combined approach utilizing both AI insights and medical expertise prioritizes effective and efficient evaluation and management, tailored to the patient’s individual presentations. Through structured diagnostic steps and targeted treatment options, this approach aims to alleviate pain, prevent complications, and improve overall patient health outcomes.
Resource Center
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Testimonials
CodyMD is a very precise and accessible app. My consultation with CodymMD is commendable and I highly recommend it for others to try CodyMD especially for assessment and consultation purposes.
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Dr Cody spot on, better than most Human Drs. Also far more pleasant. Try him, he could better help you understand your issues. He will give you good info for your Drs visit as well.
TrustPilot Review
It gave me the best response possible and suggested simple self care treatment options which I'm in favor with. It has a to the point interface and brief answer for better understanding.
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