Lower abdominal pain

case by case

In this podcast we discuss the case of

19 year old female with a history of abdominal pain. She had noticed the pain during a morning lecture and it had initially been mild and generalised. Early associated features included nausea, malaise and she had had two episodes of loose stool. She was a new student and had been living that lifestyle so she thought that it was probably due to alcohol.

However in the last couple of hours, the pain had significantly worsened. She described it as constant and sharp. She had vomited and didn’t feel like eating or drinking. She had no further diarrhoea, was passing urine although concentrated. She was advised to come to hospital by the 111 service. There was no PV bleeding, no malena or haeamtemasis and no urinary symptoms. Her last menstrual period was 6 weeks ago and normal, she has a very irregular cycle that can vary from 3-8 weeks.

She had well controlled asthma using salbutamol and beclomethasone, no other medications and no drug allergies. Interestingly she had had a couple of previous episodes of right lower abdominal pain before - although not as bad as this, this was when she was diagnosed and treated for pelvic inflammatory disease 18 months ago. She was a non-smoker, denied illicit drugs, being a new student she had been drinking more alcohol than usual.

Exam
She still looked uncomfortable - scoring pain 5/10. She was alert and orientated. Her vital signs were stable but she had a HR of 104, BP 104/62, RR 16, Sp02 100% and a temperature of 37.8*. The abdomen was soft but was mildly tender in the epigastrium and tender with some guarding in the right lower quadrant. Rovsings positive. Murphy's negative. Rebound tenderness. Bowel sounds slightly increased.

Have a listen to the podcast for the differential diagnoses and to find out what happened.

Music by BenSound.