Abdominal Pain

(Cardiopulmonary): ACS/MI, Aortic Dissection, AAA Rupture, Pneumonia, Pulmonary Embolism

(Hepatopancreatobiliary): Pancreatitis, Biliary Tract Disorders, Cirrhosis, Acute Hepatic Failure

(Gastrointestinal Tract): Esophagitis, Gastritis, Peptic Ulcer Disease, Constipation/Impaction, Gastroenteritis, Diverticu-losis/litis, Small Bowel Obstruction, Hernias, Mesenteric Ischemia, Appendicitis, Perforations

(Genitourinary): UTI/Cystitis, Pyelonephritis, STI, Pregnancy, Torsions, Abnormal Uterine Bleeding

(Endocrine): DKA/HHS, Hyperemesis Syndrome

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Patient is a *** year-old *** presenting for [acute/chronic] [location] abdominal pain. Vitals unremarkable. Physical exam without peritoneal signs. Ordered relavent labs/imaging, as needed, while treat patient symptomatically.

Differentials considered, but not limited to: 

Patient's presentation not consistent with ACS/MI given negative troponin and no arrhythmias or acute ischemic changes or acute T-wave inversion noted on EKG. CXR without acute cardiopulmonary findings. No clinically significant electrolyte abnormality. No leukocytosis or anemia, suggestive of infectious processes.

UA not consistent with UTI/Cystitis. bHCG negative for pregnancy. Clinical history not suggestive of peptic/duodenal ulcers. Pancreatitis less likely given non-elevated lipase. LFTs not suggestive of acute biliary tract disorders such as cholecystitis, acute cholangitis, or choledocolithiasis.

• POCUS of the gallbladder unremarkable.

• Pelvic examination not concerning for PID or TOA. Ovarian torsion, considered, but not consistent with clinical history and physical examination.

CT imaging without acute intra-abdominal pathology making diverticulitis, hernias, appendicitis, obstructions, or perforations less likely. Lactate non-elevated and CT findings less concerning for mesenteric ischemia, considered the possibility of a CT angiography, but at this point likely no benefit.

• Considered mesenteric ischemia as a possible cause, but low-suspicion based on clinical history and physical examination. 

DISPOSITION: HOME
Given the above findings, the patient's symptoms and work-up are not consistent with acute life-threatening etiology. Their clinical presentation and symptoms are suggestive of ***. Will discharge patient with PPI/H2-Blockers/Sulcrafate/Antacids. Recommend patient to follow-up for further outpatient management and work-up. 

DISPOSITION: ADMISSION
The current presentation is concerning for ***. Given the patient's clinical presentation, diagnostic findings, and need for continued monitoring, treatment, and further diagnostic evaluation, the patient is not appropriate for discharge from the ED. Case discussed with ***, who accepts the patient for admission.