Emergency Medicine

27 year old man presenting with RLQ abdominal pain

Amrit Misra on May 23, 2013

27 year old male presents to the Emergency Department with an 6 hr history of sudden onset, non-radiating RLQ pain.  Patient denies any palliating or aggravating factors, noting that the pain is sharp and constant.  He has never had pain like this before and is uncertain what incited it.  He reports feeling nauseous and subjective fevers/chills, but denies chest pain, shortness-of-breath, diarrhea, constipation, dysuria, or hematochieza.

PMHx: Type 1 diabetes. 

PSHx/FMHx: Unremarkable

Medications: Insulin

Allergies: No known drug allergies

Social:  Denies tobacco use, reports occasional alcohol use.

  • Temp  39 C
  • HR  130
  • BP  100/60
  • RR  25
  • O2  92% on

Physical Exam:

General: Uncomfortable appearing man, laying on examination table.

Heart: Tachyardic, regular rhythm, s1 and s2 audible.  No murmurs, rubs, or gallops.

Lungs: Clear bilaterally to auscultation, with no wheezes, rales, or rhonchi audible.

Abdominal: Diffuse tenderness to palpation in RLQ, with guarding and rebound tenderness.

MSK: No CVA tenderness

27 year old male presents to the Emergency Department with an 6 hr history of sudden onset, non-radiating RLQ pain.  Patient denies any palliating or aggravating factors, noting that the pain is sharp and constant.  He has never had pain like this before and is uncertain what incited it.  He reports feeling nauseous and subjective fevers/chills, but denies chest pain, shortness-of-breath, diarrhea, constipation, dysuria, or hematochieza.

PMHx: Type 1 diabetes. 

PSHx/FMHx: Unremarkable

Medications: Insulin

Allergies: No known drug allergies

Social:  Denies tobacco use, reports occasional alcohol use.

  • Temp  39 C
  • HR  130
  • BP  100/60
  • RR  25
  • O2  92% on

Physical Exam:

General: Uncomfortable appearing man, laying on examination table.

Heart: Tachyardic, regular rhythm, s1 and s2 audible.  No murmurs, rubs, or gallops.

Lungs: Clear bilaterally to auscultation, with no wheezes, rales, or rhonchi audible.

Abdominal: Diffuse tenderness to palpation in RLQ, with guarding and rebound tenderness.

MSK: No CVA tenderness

11,806  views

  1 like

  0 comments