Clinical Case Database / Category: Clinical Care
The differentials of right upper quadrant pain and the peril of diagnostic anchoring
Mr James Read, MRCS MSc
Foundation Years Journal, volume 6, issue 7, p.48 (123Doc Education, London, July 2012)
Emergency surgical admissions are some of the sickest patients in the hospital and it is important that at their initial assessment appropriate management is instigated. Senior clinicians reviewing such cases will recognize the pattern of presenting history and clinical signs which allows them to make a diagnosis based on their experience. Unfortunately mistakes are made and we highlight a case from our experience that recurrently presents in surgical practice. The following discussion highlights an atypical presentation that junior doctors should be reminded of each time a patient is referred to them with right upper quadrant pain. We discuss the learning points from this case and suggest further reading for interested trainees.
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Mr James Read, MRCS MSc (Corresponding author)
StR4 in general surgery to Miss Vig, Croydon University Hospital
1. I C Martin, D.G.M., J Stewart, M Mason, N C E Smith, K Gill, Emergency Admissions: A journey in the right direction? 2007, National Confidential Enquiry into Patient Outcome and Death.
2. Redelmeier, D.A., The Cognitive Psychology of Missed Diagnoses. Annals of Internal Medicine, 2005. 142(2): p. 115-120.
3. Dellinger RP, L.M., Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL;, Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med., 2008. 36(1): p. 296-327.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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