Case Report
A 55-Year-Old Woman
with Abdominal Pain
Urgent message: Noting ‘red flags’ specific to the individual patient is of
key importance when details of the presentation do not add up.
Jill Chavinson Miller, MD
J Observations and Findings
The patient appeared healthy and comfortable, in no dis-
tress at presentation.
Ⅲ Past medical/surgical history: hysterectomy
Ⅲ Medications: estrogen
Ⅲ Allergies: sulfa
Ⅲ Social history: social drinker,
w w w. j u c m . c o m
non-smoker Ⅲ Physical: t-98.5, p 86, r 12, bp
138/84, O2 sat 98% ra
Ⅲ HEENT: normal
Ⅲ Resp: normal; good air
exchange Ⅲ CV: RRR no m/r/g, equal
pulses throughout
Ⅲ ABD: non-distended; BS
normal. Soft, diffusely tender
to palpation in the lower
abdomen and bladder; also:
– no guarding or rebound
– negative Murphy’s sign
– no masses or hernia
appreciated – no abdominal bruits.
Ⅲ Back: no CVA tenderness
Ⅲ Skin: no rashes; warm
and dry
Ⅲ Neuro: non-focal, alert and
appropriate Ⅲ Urinalysis: SG 1.015; ph 6.5; LEU 75; NIT POS;
PRO 30; GLU norm; KET 150; UBG norm; BIL
neg; BLD 50
Ⅲ Chemistry: glucose 138 (65-110); sodium 130
(135-145); potassium 3.8 (3.5-5.5); chloride 98
(95-107); Bun 10 (5-23); Cr 0.7mg/dL
Ⅲ CBC with diff: WBC 17.3 (4.4-11.3); RBC 4.71 (4.0-
5.2); HGB 14.9 (12.0-16.0); HCT 42.8 (36.0-46.0);
neutrophil 15.36 (1.2-7.70); lymphocyte 1.12
(1.20-4.80); monocyte 0.80 (0.10-1.00); eosinophil
0.00 (0.00-0.70), basophil 0.02 (0.00-0.10)
© David Raymer/Corbis
.W. is a 55-year-old female
who presented with abdomi-
nal pain. She reported that
the pain woke her up the
night before and lasted all day
long, which prevented her from
doing much that day. She
described the pain as constant
and gnawing, assessing its sever-
ity as 6 on a scale of 10.
The pain is located in her
lower abdomen diffusely and
does not radiate. She denies any
fever, chills, nausea or vomiting.
In addition, she reports:
Ⅲ no diarrhea
Ⅲ no frequency or urgency
Ⅲ no back pain
Ⅲ no chest pain or any respira-
tory complaints
J.W. is drinking fluids without
difficulty. There were no allevi-
ating or aggravating factors.
She lives elsewhere and is in town visiting her son and
daughter-in-law to help with their baby.
JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | A p r i l 2 0 0 7
29