Patient Details

Simon Williams

77

M

Metformin XR 2g PO mane

Lantus 30 units S/C nocte

Actrapid 20 units S/C mane, 10 midday, 20 units nocte.

Telmisartan 80mg PO mane

Hydrochlorothiazide 12.5mg PO mane

Atorvastatin 40mg PO nocte

Aspirin 100mg PO mane

Metoprolol 25mg PO BD

Nitrolingual pump 1 spray S/L PRN

Mr Williams presents to the Armidale Hospital Emergency Department in the company of his daughter with severe epigastric pain. This is a persistent pain that started as right upper quadrant pain yesterday that had continued to worsen. It has migrated to the epigastrium and radiates through to the back. This appears to be exacerbated by deep breathing but there is some relief when sitting forward. There had also been associated nausea and vomiting.

Mr Williams has previously had an episode of right upper quadrant pain and he presented to the emergency department on that occasion. An ultrasound was performed revealing cholelithiasis with no cholecystitis. He was advised to see a surgeon but has not done so as yet.

Mr Williams had otherwise recently been well.

Appendicectomy

Tonsillectomy

Transurethral resection of the prostate (TURP)

Insulin dependent Type 2 diabetes

Ischaemic heart disease

Hypertension

Dyslipidaemia

NKDA  

Mr Williams’ mother died of breast cancer and his father died of an AMI.     

Mr Williams is a retired mechanic who lives alone  in Armidale. His wife died four years ago after a long battle with metastatic breast cancer. He has the support of a daughter (Mary) who lives close by and helps with some of the washing, cooking and shopping. He walks independently inside his house but uses a walking stick outside the house for support.

He is a non-smoker and only drinks on occasion.