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, Dyspepsia, GERD, 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

Physical Exam:

Abdominal: Non-distended. No visible rashes, bruising, markings, pulsitility, and/or varices. Normal bowel sounds. No tenderness to palpation in the RUQ/Epigastric/LUQ/LLQ/Suprapubic/RLQ/Umbilical regions. No signs of peritonitis.

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Patient is a *** year-old *** presenting for *** abdominal pain. Vitals reviewed. Physical exam without peritoneal signs. Ordered relevant labs/imaging. Will 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. Wells ***. 

Patient without clinical symptoms of pain with/before eating, burping, fullness after eating, bloating, reflux symptoms, less likely dyspepsia, gastritis, or GERD. No significant nausea, abdominal pain, and/or diarrhea which are consistent with gastroentertitis. Clinical history/exam not consistent of peptic/duodenal ulcers. 

UA*** not consistent with UTI/Cystitis. bHCG*** negative for pregnancy. Pancreatitis less likely given non-elevated lipase***. LFTs*** not suggestive of acute biliary tract disorders such as cholecystitis, acute cholangitis, or choledocolithiasis. Hepatic causes also less likely. Patient denies any genitourinary discharge*** which would be concerning for GC/CT. 

• 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.

• Considered PID or TOA, however clinical history not consistent with this diagnosis.

• Considered Torsions, however clinical history is not consistent with this diagnosis.

• No reported symptoms of AUB.

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.