A 57-year-old woman with abdominal pain (original) (raw)

A woman in her nineties with acute peritonitis

Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 2014

A woman in her nineties was admitted to hospital with acute abdominal pain. She had recently been discharged following treatment for severe acute cholecystitis with intravenous antibiotics and percutaneous biliary drainage. She was taking a number of drugs for other diseases, in addition to peroral antibiotics and analgesics following her former hospitalisation. She had reduced vision and used a dental prosthesis. On admission she was alert and aware of the situation, but her general condition was rather poor and she reported diffuse abdominal pain. She had a low-grade fever (38.3 °C), slight tachycardia (regular pulse of 83 beats per minute), slightly reduced oxygen saturation in ambient air (89 %) and normal blood pressure (151/83 mm Hg). Clinical examination of the abdomen revealed distension on palpation and general pressure and rebound tenderness.

A patient with recurrent acute abdominal pain

Postgraduate Medical Journal, 1999

A 48-year-old Jewish woman presented to the emergency room complaining of sharp epigastric abdominal pain of acute onset. The pain was non-radiating and severe in intensity and had started 6 hours prior to presentation. It was associated with nausea and vomiting. The vomitus consisted of food particles. She denied complaints of diarrhoea, constipation, melaena, haematemesis or weight loss. The physical examination revealed a blood pressure of 110/64 mmHg, pulse rate 60 beats/min, temperature 38.2°C, and a respiratory rate of 16 breaths/min. She weighed 48 kg. She was anicteric and had no cervical lymphadenopathy. The abdomen was soft and diVusely tender. Rigidity, rebound tenderness, hepatosplenomegaly or masses were absent. Rectal examination showed guaiac-negative brown stool. The remainder of the examination was unremarkable. The patient was not taking any medications and denied use of alcohol, tobacco or intravenous drugs. Her diet consisted mainly of low fat vegetarian food products. Her family history was unremarkable. A review of patient's medical records showed documentation of similar episodes on at least six occasions over the previous 18 months. During the attacks, the pain lasted 48 to 72 hours and was associated with a low-grade fever (37-38.5°C). Medical history was significant for long-standing back pain and degenerative joint disease involving the knees (for at least 15 years). There was a history of self-limited episode of viral meningitis 1 year prior to presentation. She had undergone tubal ligation 10 years prior to the onset of abdominal pain, followed by a laparotomy 6 years later for evaluation of pelvic pain. Adhesions were discovered during the laparotomy. The investigative work-up failed to reveal a definite diagnosis. On numerous occasions, laboratory data including complete blood count, erythrocyte sedimentation rate, and routine blood chemistry were within normal limits, except for minimal elevation of white blood cell count on two occasions. Antinuclear antibody assay was negative. Abdominal ultrasound and a HIDA scan did not reveal any abnormalities. Abdominal X-ray, upper gastrointestinal barium study, and a colonoscopy were normal. Computed tomography of the abdomen and pelvis was unremarkable. The patient was admitted to the hospital for observation, as diagnostic studies were unrevealing. She became asymptomatic within 24 hours and was discharged home. Questions 1 What is the diagnosis ? 2 Describe the pathogenesis of this clinical condition ? 3 How was the diagnosis made ? 4 Describe the most recent development in the diagnosis of this condition ? 5 What is the treatment ?

A 28 Year-Old Female with Lower Abdominal Pain

Dalhousie Medical Journal, 2014

A 28-year-old nulligravida presented to the emergency department with a two day history of lower abdominal pain. Initially the pain was dull and diffuse, but it had progressed to a sharp sensation in the right lower quadrant. She stated that she was currently menstruating and has a regular 28-day menstrual cycle. However, upon further questioning, her last menstrual period (LMP) was 45 days ago and this period was lighter than usual. Physical examination revealed normal vital signs (HR 86, BP 114/72, RR 19, SpO2 99%, temperature 37.8°C) and tenderness to palpation in the right lower quadrant. Pelvic examination demonstrated right adnexal fullness. She had a remote history of Chlamydia trachomatis infection, but was otherwise healthy. A serum β-hCG was 2400 mIU/mL; therefore, a transvaginal ultrasound was performed ).

A 33-year-old white female with abdominal pain, nausea, vomiting and hypotension

Journal of Emergency Medicine, 1993

A thirty-three year old female presented to our emergency department complaining of severe abdominal pain, nausea, and vomiting. On physical examination she was hypotensive with a firm, tender abdomen, cervical motion tenderness and a diffuse erythematous rash. A surgical diagnosis of Acute Pelvic Inflammatory Disease was made during laparoscopy. Coagulant studies, liver function tests, culture results, and the desquamation of the patient's palms led to the additional diagnosis of Toxic Shock Syndrome. A literature search failed to reveal any similar cases of Pelvic Inflammatory Disease (PID) and Toxic Shock Syndrome (TSS) occurring concomitantly. Patients may present severely ill with either of these disease entities but potential for serious illness is greater when both of these syndromes occur in the same patient. We conclude that in patients with a similar presentation, the symptoms should not be attributed completely to PID without further investigation and consideration of a concomitant disease process including TSS.

A Common Disease With an Unusual Complication of Acute Abdomen

Gastroenterology, 2012

Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day duration of progressive and diffuse abdominal pain. The pain, seemingly unrelated to meals or postural change, began with intermittent cramps and progressed to a steady, constant ache. Physical examination revealed marked lower quadrant tenderness, diffuse peritoneal sign, and reduced bowel sounds. Deep tenderness at McBurney's point was not obvious. Laboratory investigation disclosed leukocytosis with a left shift, and the remaining tests were unremarkable. Contrast-enhanced computed tomography (CT) was performed (Figure A). What is your diagnosis and management? See the GASTROENTEROLOGY web site (www.gastrojournal .org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.