Abdominal Pain

Author:

Daniel J. Dire, MD

Affiliations:

Assistant Professor and Research Director
Section of Emergency Medicine and Trauma
Department of Emergency Medicine
University of Oklahoma Health Sciences Center (DJD)

Chief Complaint:

History of the Present Illness:

A 22-year-old man presents to the emergency department (ED) with a 1 day history of right lower quadrant abdominal pain. Associated symptoms include nausea, vomiting, and anorexia. He denies fever, weight loss, abnormal bowel movements, risk factors for immunocompromising disorders, previous surgeries or medical problems. The patient reports that the same symptoms occurred intermittently over the last several months with each episode resolving spontaneously. He did not seek medical care for prior episodes of pain.

Physical Examination:

The patient's vital signs are normal except for an oral temperature of 100.6o (F). He appears in obvious pain. His HEENT, pulmonary, and cardiovascular examinations are normal. His abdominal examination is remarkable for decreased bowel sounds and localized right lower quadrant tenderness to palpation. Rebound tenderness is present, No masses are palpated. Psoas and heel strike signs are present. A rectal examination demonstrates tenderness toward the right lower quadrant, a normal prostate, and guaiac-negative stool.

Laboratory analysis:

A urinalysis, complete blood count, serum electrolytes, glucose, blood urea nitrogen, creatinine, liver function tests, and amylase level are all within the normal ranges. A chest radiograph is normal. A supine abdominal radiograph is shown (Figure 1).

The patient course, diagnosis and discussion

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