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
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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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 could cause severe back pain that radiates to the abdomen?
How do you differentiate between kidney stones and a herniated disc?
Can severe back pain lead to nausea?
What are common symptoms of a herniated disc?
How do hormonal changes affect back pain in women?
Why does sitting worsen back pain?
What initial treatments are recommended for severe back pain?
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! I’m Cody, your AI Doctor trained by human doctors.
Patient
I have severe back pain on my lower back
Cody, the AI Doctor
So you want to focus on your severe back pain along your vertical column today, is that correct?
Patient
Yes
Cody, the AI Doctor
Let’s get to the bottom of your back pain. Can you describe the nature of your back pain? For example, is it sharp, dull, throbbing, or burning? Does it radiate to any other areas, like your legs or arms?
Patient
It is a very sharp pain that radiates to the abdomen and lower chest and sometimes radiates to my bladder.
Cody, the AI Doctor
Alright, noted. When did you first start experiencing this severe back pain along your vertical column? For example, did it start a few days ago, a couple of weeks ago, or even longer?
Patient
4 days
Cody, the AI Doctor
It's important to note that back pain can sometimes be caused by recent activities or injuries, so understanding when it started can help pinpoint the cause and guide treatment options. Have you been diagnosed with any medical conditions related to your back or spine? For example, herniated discs, scoliosis, or arthritis?
Patient
I've had a hemorrhagic cyst in the ovary
Cody, the AI Doctor
Ah, I see. In what year were you born?
Patient
1999
Cody, the AI Doctor
Got it! Knowing your age helps me tailor my advice and recommendations to your specific needs, especially when it comes to back pain, as different age groups can experience different underlying issues. Can you please tell me your sex? For example, are you male, female, or prefer not to say?
Patient
Female
Cody, the AI Doctor
Thanks for sharing! It's important to note that women can experience back pain differently than men, often due to factors like hormonal changes, pregnancy, or osteoporosis. Can you describe the specific location of your severe back pain along your vertical column? For example, is it in the lower back, mid-back, or upper back?
Patient
Mid back.
Cody, the AI Doctor
Ah, I see! Mid-back pain can often be related to muscle strain, poor posture, or even stress. How has your severe back pain been changing over the past few days? For example, is it getting worse, getting better, staying the same, or does it vary from day to day?
Patient
Getting worse
Cody, the AI Doctor
Got it. Can you tell me how your severe back pain started? For example, did it come on suddenly, like after lifting something heavy, or did it develop gradually over time?
Patient
Gradually over 4 days
Cody, the AI Doctor
Gradual onset of back pain can often be linked to factors like poor posture, muscle strain, or even degenerative changes in the spine. On a scale of 1 to 10, how would you rate the severity of your back pain right now, where 1 is no problem and 10 is very severe?
Patient
10
Cody, the AI Doctor
Wow, a 10 is definitely severe! It's important to address that level of pain as soon as possible. Have you noticed any specific activities or movements that make your severe back pain worse or better? For example, does bending, lifting, or sitting for long periods affect your pain?
Patient
Yes, sitting and bending make it worse.
Cody, the AI Doctor
Got it! IAre you experiencing any other symptoms along with your back pain? For example, do you have any swelling, redness, or limitations in your range of motion?
Patient
No, none of those.
Cody, the AI Doctor
And what about pain with urination? Or nausea?
Patient
No trouble peeing, but I do have some nausea.
Cody's AI Summary
- You are a 25-year-old woman with severe back pain.
- Your back pain is sharp and radiates to your abdomen and lower chest.
- You have been experiencing this pain for 4 days.
- You have a hemorrhagic ovarian cyst in the past.
- You were born in 1999 and identify as female.
- Your severe back pain is located in the mid-back.
- Your pain has been getting worse over the past few days.
- The pain started gradually.
- You rate your pain as a 10 out of 10.
- You have noticed that sitting and bending make your pain worse.
- You do not have any other symptoms like swelling, redness, or limitations in your range of motion. But you do have nausea.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Kidney Stone(40 % probability)
Sharp pain in the back that radiates to the abdomen can indicate kidney stones.
2. Herniated Disc(35 % probability)
A herniated disc can cause severe back pain and may radiate to other areas.
3. Pancreatitis(25 % probability)
Inflammation of the pancreas can cause severe abdominal and back pain.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
The history suggests severe pain that worsens with certain positions, indicative of spinal origins such as a herniated disc. However, the presence of radiating abdominal pain and nausea raises suspicion for intraabdominal issues like kidney stones or pancreatitis. A 25-year-old woman with known ovarian cysts may also have gynecologic considerations. Here are my additional comments with adjusted probabilities:
1. Herniated Disc(50% probability)
The patient's severe pain, exacerbation with sitting and bending, and mid-back location are highly suggestive of a spinal issue. The sharp nature of the pain and its gradual onset are consistent with disc herniation, especially as the pressure on spinal nerves often correlates with posture-related pain worseners.The absence of limb numbness or weakness slightly diminishes this probability but does not rule it out, as these too can develop later in progression.
2. Kidney Stones(30% probability)
Sharp radiating pain and associated abdominal discomfort often align with kidney stones, and the nausea supports this diagnosis. Kidney stones can cause intense colicky pain that might be confused with back pain. Typically, kidney stones might present with hematuria or urinary symptoms, like frequency, which the patient denies. This lack diminishes the likelihood slightly.
3. Pancreatitis(15% probability)
The radiating abdominal pain coupled with nausea points towards pancreatitis, which often presents with epigastric and back pain. Pancreatitis can be caused by gallstones or alcohol use, which would need to be assessed. But the absence of abdominal findings like tenderness, and lack of known risk factors such as alcohol use or recent gallbladder issues, reduce its probability.
4. Other Considerations:
Ovarian Cyst Rupture (5% probability): Could account for pain radiating to the abdomen and nausea. The patient's history of an ovarian hemorrhagic cyst could lead to pain if aggravated or ruptured, which occasionally refers to the back and abdomen. Additional gynecologic evaluation would be needed to explore this. However, although there's history, the presentation is less typical for an active gynecological issue without significant pelvic findings or menstrual irregularities.
Next Steps for Evaluation
Diagnostic Testing:
For definitive diagnosis, starting with a thorough physical examination and then initiating laboratory work for renal function and pancreatic enzymes and urinalysis, along with imaging studies such as CT or MRI, will be essential. Depending on findings, further specific interventions can be recommended, like urological procedures for stones or potentially surgical evaluations for disc issues.
Potential Treatment Modalities for Herniated Disc
Conservative Management:
Pain Relief: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation. Acetaminophen may be recommended for patients who cannot tolerate NSAIDs.
Physical Therapy: Tailored exercises to strengthen back muscles, improve posture, and increase flexibility. This can help alleviate pressure on the nerve and mitigate pain.
Rest and Lifestyle Modifications: Short periods of rest followed by gradual activity increases. Avoidance of activities that exacerbate pain, like heavy lifting and prolonged sitting, can also help
Chiropractic Care and Osteopathy: Sometimes helpful in specific cases where realignment can relieve nerve pressure. However, it is essential this is conducted by certified professionals.
Acupuncture: Some patients find relief from chronic pain through alternative treatments such as acupuncture.
Advanced Interventions:
Epidural Steroid Injections: To reduce inflammation and help alleviate pain, injections can be targeted to the area around the herniated disc.
Surgical Options:
Microdiscectomy: The most common surgery for a herniated disc involves removing the portion of the disc that is pressing on the nerve.
Laminectomy: Less common, this procedure removes part of the vertebral bone to provide more space for the nerves, alleviating pressure.
Conclusion
Severe mid-back pain with abdominal radiation in a young woman requires careful analysis of spinal, renal, and gynecological causes. Initial evaluation should prioritize ruling out acute conditions like kidney stones, especially given the nausea and pain severity.
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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