Lower Abdominal Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍lower abdominal pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent, worse during the ‍day

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

‍changes in bowel habits

‍bloating

‍flatulence

‍inability to pass gas

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍loss of appetite

‍pelvic pain

‍missed period, ‍one cycles missed, ‍possibility of pregnancynot sexually active

‍vaginal bleeding

‍hematuria

‍dysuria

‍urinary frequency



Contributing factors:

‍heavy alcohol consumption

‍smoking

‍recent travel

‍food allergies or intolerances

‍high fat diet

no history of: ‍diverticulosis, ‍colon cancer or polyps, ‍hernia, ‍ovarian cysts, ‍prostatitis, ‍kidney stones, ‍urinary tract infections, ‍ectopic pregnancy, ‍endometriosis, ‍abdominal surgeries

no use of: ‍oral contraceptives





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

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





ASSESSMENT:

‍Diverticulitis ‍likelysuspectedpossible

DDx: diverticulitis, appendicitis, urinary tract infection, pelvic inflammatory disease, ectopic pregnancy, ovarian cyst, constipation, functional abdominal pain, inguinal hernia, irritable bowel syndrome, inflammatory bowel disease, colitis, small bowel obstruction, colorectal cancer, mesenteric lymphadenitis, mesenteric ischemia, endometriosis, fibroids, miscarriage, ovarian torsion, prostatitis, testicular torsion, bladder stones, urinary retention





PLAN:

Investigations:

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

- Urinalysis, urine culture

- Abdominal X-ray

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- Upper GI endoscopy

- Colonoscopy

Treatments:

- ‍PPIs

Further care:

- Referral to gastroenterologist

- Referral to surgeon

- Follow-up in ‍ ‍daysweeks

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