A 63 year-old female presents with chief complaint of severe abdominal pain. The patients reports walking out of a department store this afternoon when she experienced an abrupt onset of sharp abdominal pain rated as a 10/10 that has not improved since arriving to the emergency department.
The patient describes pain involving her entire abdomen, though it seems worse in the upper half than the lower half. She denies associated nausea or vomiting but does endorse feeling bloated. The patient remembers having cereal and milk for breakfast this morning, as well as a normal bowel movement earlier today that was non-bloody.
She denies having fevers, chills, chest pain, or shortness of breath.
Exam is remarkable for diffuse abdominal tenderness in all 4 quadrants, no peritoneal signs and positive bowel sounds.
The patient describes pain involving her entire abdomen, though it seems worse in the upper half than the lower half. She denies associated nausea or vomiting but does endorse feeling bloated. The patient remembers having cereal and milk for breakfast this morning, as well as a normal bowel movement earlier today that was non-bloody.
She denies having fevers, chills, chest pain, or shortness of breath.
Exam is remarkable for diffuse abdominal tenderness in all 4 quadrants, no peritoneal signs and positive bowel sounds.
Laboratory tests including a CBC, CMP, lipase, and urine analysis are sent and pending.
In addition, a CXR is obtained:
Can you guess the diagnosis?
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The actual diagnosis for this real-life case will be posted in 1 week.
Upgrade to high acuity area. Surg consult. IVF boluses. .1mg/kg morphine. CT abd pelvis PO IV contrast. NG tube. Central line. Possible art line.
ReplyDeleteSome kind of perf leading to free air in abd. Maybe a diverticulum perf? Pretty sure they're going to OR shortly.
ReplyDelete