MEDizzy - In the patient A 28-year-old woman presents to the emergency

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Cardinal Manifestations and Presentation of Diseases 1

In the patient A 28-year-old woman presents to the emergency department with 8 hours of worsening abdominal pain. She describes the pain as steady, aching, and located in the lower middle to right abdomen. Any movement worsens the pain. She denies any hematemesis, melena, or bright red blood in stools. She is sexually active with four to six partners over the last 6 months. Her only medication is an oral contraceptive. On physical examination, her temperature is 39.0°C, blood pressure is 110/75 mmHg, heart rate is 105 bpm, and respiratory rate is 18 breaths/min. Her abdominal examination is notable for tenderness below and to the right of the umbilicus with positive rebound. Any movement causes immediate worsening of the pain. Bowel sounds are diminished. Serum pregnancy test is negative. described which of the following is the most likely diagnosis?

ExplanationThe answer is B. Of the causes listed, pelvic infammatory disease causes pain due to parietal peritoneal infammation, plus the patient is at risk with her sexual activity with multiple partners. Acute cholecystitis causes pain by distension of the gallbladder viscera. Sudden distention of the biliary tree produces a steady rather than colicky type of pain; hence, the term biliary colic is misleading. Acute distention of the gallbladder usually causes pain in the right upper quadrant with radiation to the right posterior region of the thorax or to the tip of the right scapula, but it is also not uncommonly found near the midline. Distention of the common bile duct often causes epigastric pain that may radiate to the upper lumbar region. Considerable variation is common, however, so that diferentiation between these may be impossible. Rectus sheath hematoma causes pain related to abdominal wall distension. Small bowel obstruction often presents as poorly localized, intermittent periumbilical or supraumbilical pain. As the intestine progressively dilates and loses muscular tone, the colicky nature of the pain may diminish. With superimposed strangulating obstruction, pain may spread to the lower lumbar region if there is traction on the root of the mesentery.