LLQ Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of left lower quadrant pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍bloating

‍flatulence

‍dysuria

‍urinary frequency

‍hematuria

‍menstrual irregularities

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor



Contributing factors:

‍recent travel

‍food allergies or intolerances

‍high-fiber diet

no history of: ‍diverticulitis, ‍inflammatory bowel disease, ‍hernia, ‍ovarian cysts, ‍ectopic pregnancy, ‍kidney stones, ‍urinary tract infections, ‍previous abdominal surgeries

no use of: ‍oral contraceptives, ‍anticoagulants





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍ß-hCG, ‍lactate

- Urinalysis, urine culture

- Abdominal X-ray

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- Pelvic ultrasound

- STI screening for chlamydia and gonorrhea

- Colonoscopy

- Fecal occult blood test

Treatments:

- Dietary modifications

- ‍Analgesics

- ‍Antiemetics

- ‍Antibiotics

- ‍Stool softeners

Further care:

- Referral to gastroenterologist

- Referral to general surgeon

- Referral to gynecologist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens or if new symptoms develop such as fever, vomiting, or blood in stools

- Referral to ER if severe pain, fever, or signs of peritonitis