Abdominal Pain
Male - No CT Scan
-VS unremarkable
-Overall well appearing. Abdomen is completely soft and non-tender. No evidence of peritonitis/surgical abdomen. Negative Murphy’s sign, no ttp at McBurney’s point. Low risk for AAA and exam/history doesn’t support it. Pancreatitis seems unlikely but is possible. No flank pain to suggest pyelo or nephrolithiasis.
-No indication for CT at this point.
-Seems most likely to be due to functional cause rather than acute surgical etiology or infectious etiology other than possibly UTI, viral illness.
-Getting basic abdominal pain labs and will treat symptomatically
Re-exam, normal, DC
Labs unremarkable. Patient resting comfortably. Repeat abdominal exam still without any evidence of surgical abdomen or peritonitis requiring higher level imaging. Patient states they feel much better and would like to go home. We discussed that although the labs were reassuring, there could still be a developing occult infection or surgical process that has not fully manifested at this time. I also discussed again why I did not think CT imaging was appropriate at this time and they agreed. Return precautions were extensively discussed and they will see their primary within the next 48hours or to return to the ER for a re-exam. The patient understands to return for any worsening symptoms or failure to improve, especially over the next 12-24 hours.
Male - CT Scan
-VS unremarkable
-Overall sick appearing. No abnormal cardiopulmonary findings. Moderate abdominal ttp. No guarding. Surgical process seems possible given the exam and presentation. History and exam doesn’t suggest AAA so no indication for CTA. No evidence of infection at this point so holding ABX for now. Could be a benign cause of pain although dangerous pathology needs to be ruled out first
-CT abd/pelv w/contrast
-Abdominal pain labs, analgesics
Re-exam, normal, DC
CT without acute pathology and labs reassuring. Patient resting comfortably. Patient states they feel much better and would like to go home. We discussed the limitations of CT imaging and that no test is perfect at finding all abnormalities. I discussed that the overall picture at this point is of a likely functional rather than surgical or infectious process. They understood. I did offer admission for further observation and care if they would like but they opted for home observation and outpatient therapy. Return precautions were extensively discussed and they will see their primary within the next 48hours or to return to the ER for a re-exam. The patient understands to return for any worsening symptoms or failure to improve, especially over the next 12-24 hours.
Female - No CT Scan
-VS unremarkable
-Overall well appearing. Abdomen is completely soft and non-tender. No evidence of peritonitis/surgical abdomen. Negative Murphy’s sign, no ttp at McBurney’s point. Low risk for AAA and exam/history doesn’t support it. Pancreatitis seems unlikely but is possible. No evidence of suprapubic/adnexal area tenderness and no report of discharge so PID/TOA seems unlikely. Ectopic always a possibility.
-No indication for CT or US at this point.
-Seems most likely to be due to functional cause rather than acute surgical etiology or infectious etiology other than possibly UTI, viral illness.
-Abdominal pain labs, analgesics
Re-exam, normal, DC
Labs unremarkable. Patient resting comfortably. Repeat abdominal exam still without any evidence of surgical abdomen or peritonitis requiring higher level imaging. Patient states they feel much better and would like to go home. We discussed that although the labs were reassuring, there could still be a developing occult infection or surgical process that has not fully manifested at this time. I also discussed again why I did not think CT imaging was appropriate at this time and they agreed. Return precautions were extensively discussed and they will see their primary within the next 48hours or to return to the ER for a re-exam. The patient understands to return for any worsening symptoms or failure to improve, especially over the next 12-24 hours.
Female - CT Scan
-VS unremarkable
-Overall sick appearing. No abnormal cardiopulmonary findings. Moderate abdominal ttp. No guarding. Surgical process seems possible given the exam and presentation. History and exam doesn’t suggest AAA.No evidence of infection at this point so holding ABX for now. Could be a benign cause of pain although dangerous pathology needs to be ruled out first. No evidence of suprapubic/adnexal area tenderness and no report of discharge so PID/TOA seems unlikely. Even so, CT is sensitive enough to likely pick up TOA. Ectopic always a possibility.
-CT abd/pelv w/contrast
-No indication for US at this point
-Abdominal pain labs, preg test, analgesics
Re-exam, normal, DC
CT without acute pathology and labs reassuring. Patient resting comfortably. Patient states she feels much better and would like to go home. We discussed the limitations of CT imaging and that no test is perfect at finding all abnormalities. I discussed that the overall picture at this point is of a likely functional rather than surgical or infectious process. She understood. Given the location of her pain and the overall clinical picture, I think torsion, toa, or other significant pelvic process is highly unlikely and do not think US is necessary at this time. I did offer admission for further observation and care if she would like but she opted for home observation and outpatient therapy. Return precautions were extensively discussed and shew ill see their primary within the next 48hours or to return to the ER for a re-exam. The patient understands to return for any worsening symptoms or failure to improve, especially over the next 12-24 hours.
- Last updated January 28, 2023