Abdomen Pain.... Not sure what the cause could be..

riems

riems

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I had a 64 YO male. high cholesterol hx, no cardiac hx, BP was 168/70 -- Pulse 68 resp 20. Pain level - 10/10.

Pt had LRQ pain that did not radiate, not sensitive to touch or palp. No back pain, no blood in urine, no trouble crapping or urinating. Just a sudden onset of pain.

Any thoughts?
 
Uhhhhh

No other symptoms? Just pain? No N&V? No pain on palpation, but was their rebound pain?
 
What's the REST...of the story?

Palpate anything? Bowels sounds? Bruises? Alteration of gait? Entry wounds (new or old)? Hx of recent analgesic (opioid) use? "Wrap around" from hip or sacral area? Has it moved? Change in urinary or bowel habits as they say? Hx GSW to torso?
We cheat in offices. We jump in do a urine dip, CBC, basic chem panel with enzymes for pancreas, liver, gallbladder, just for starters. Then we break into their house looking for toxins...:ph34r:
 
Was there a fever? No visable blood in the urine does not mean there was none. Any chance you were able to follow up and get test results?

Blood in urine?
UTI?
CBC, White cell count?
Creatine clearance?

I'm thinking appendicitis or renal colic. However much more info is required as it could be many other things.
 
Given very limited information, if you want a statistical possibility, probably kidney stone.

That would come out during history.
 
Or during an excruciating micturition.

:p
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riems said:
I had a 64 YO male. high cholesterol hx, no cardiac hx, BP was 168/70 -- Pulse 68 resp 20. Pain level - 10/10.

Pt had LRQ pain that did not radiate, not sensitive to touch or palp. No back pain, no blood in urine, no trouble crapping or urinating. Just a sudden onset of pain.

Any thoughts?
Click to expand...
Did you get a Hx of the present illness? Time of onset and quality of the pain?
DDx of LRQ abd pain includes: AAA, intestinal obstruction, hernia, appendicitis, referred pain from testicular torsion, and urinary calculus.

Acute abdominal pain is difficult to Dx even in the ER. It is unlikely that a prehospital provider would be able to accurately pinpoint the etiology of abd pain in the field setting. That does not mean you cannot form a DDx and treat accordingly. For example, since AAA and ectopic pregnancy would be included in the possible list of conditions in a female patient with the same presentation, this patient will likely need to receive IV access in case things go sour and a quick trip to the hospital.
 
No appendicitis ... had it out decades ago. No rebound pain. Had nausea but no vomiting. No urinating problems, normal Bowel movements, clear bowel sounds.

No way to follow up....


Thanks for all the suggestions.... the abdomen is a complicated thing ;)
 
Probably gas pains... or F.O.S.

R/r 911
 
riems said:
No appendicitis ... had it out decades ago. No rebound pain. Had nausea but no vomiting. No urinating problems, normal Bowel movements, clear bowel sounds.

No way to follow up....


Thanks for all the suggestions.... the abdomen is a complicated thing ;)
Click to expand...

That it is, that it is. Best thing to do is learn what is where and then research research research... learn what the s/s of different things are. Remember that sometimes you will just never know what it is out in the feild, as... "the abdomen is a complicated thing ;)"

Take Care,
 
FTS is my guess... :P
 
riems said:
No appendicitis ... had it out decades ago. No rebound pain. Had nausea but no vomiting. No urinating problems, normal Bowel movements, clear bowel sounds.

No way to follow up....


Thanks for all the suggestions.... the abdomen is a complicated thing ;)
Click to expand...
Bowel sounds are clear? What does that mean? Did you listen to each quadrant for a few minutes to determine presence or absence?

Also you did not describe the quality of the pain, which is important in a clinical history. If you want to make a Dx without labs, UA, and imaging studies, you had better have taken a solid Hx.
 
rhan101277 said:
lol f.o.s 78910
Click to expand...

That is usually the most common diagnosis for abdominal pain. The colon starts having pain as constipation and gas occurs. Usually a flat and upright, after a CBC to verify its not an appendix. IBS, diverticulitis is the other common factors.
 
You think guys' abdomens are complicated..... Us wimmens got even more options.. ovarian cysts, ectopic pregnancy, PID, endometriosis, .... the list goes on.. and on... and on....
 
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