| Station | FY2 in ED. Anna Smith a 47yo lady has presented with abdominal discomfort. Talk to the patient and examine her. Vitals T 38.5 HR 96 |
| Patient info | Abdominal pain started 4h. the pain started suddenly and progressively became worse. It’s a sharp pain that doesn’t radiate, pain is 9/10. |
| Generalized pain in the lower abdomen. You feel sick but didn’t vomit. You have loss of appetite. Any movement makes the pain worse. You felt that your abdomen is a lot swollen but now it’s okay. You have not been eating for 3days. Just drinking fluids. LMP 2weeks and on COCP. You opened your bowel 3days ago. patient is lying down on the couch and ready for examination. You have severe pain in the suprapubic area and RIF. | |
| Intro | How can I help you today? + offer painkillers after asking the questions |
| History | Explore pain + Associated symptoms: Nausea, vomiting, constipation, diarrhea, fever, when was the last time you opened your bowel? |
| Concern | Apart from this pain, what’s your main concern? |
| D.D | FLAWS |
| Appendicitis: fever, vomiting | |
| Exclude MI: SOB, Chest pain, cough | |
| Exclude peptic ulcer: Any blood in the stool | |
| Exclude obstructive Jaundice: any change in the color of stool or urine? itching? | |
| Exclude kidney stone (Acute cholecystitis): burning sensation during urination, loin pain, blood in urine | |
| P2 | Have you had such pain before? Any previous surgeries? |
| Have you been diagnosed with any medical condition? | |
| Р3 | DESA (Alcohol) (smoking) + Menstrual history +Sexual History |
| MAFTOSA (medications) | |
| Finishing Hx | Thank you for answering my questions |
| Expectations | What do you expect that might be causing your problem? |
| Examination | Observations + tummy + PR examination + PV examination + head to toe |
| Ideas | Do you have any idea what might be causing your tummy pain? |
| Provisional diagnosis | Inflammation the appendix that could have perforated and caused generalized infection in the tummy. It also could be intestinal obstruction and perforation as you told me that … |
| Management | Admit to the hospital |
| Investigations: Routine bloods (inflammatory markers, FBC, RBS) + Amylase and lipase + pregnancy test + Erect CXR for gas under diaphragm + CT scan of abdomen | |
| Treatment: NPO + IV fluids + prophylactic antibiotics according to hospital protocols | |
| We might need an operation which involves removing of the affected bowel if we find out it’s perforated. But I will discuss this with my seniors | |
| Safety netting: dizziness, fainting | |
| Closure | Please at any time if you have questions or concern, let us know |
| Questions | Rousing’s sign: if palpation of the LLQ, increase pain felt on the RLQ |
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