Mark Crislip, MD


June 01, 2011

Clinical Presentation

The patient is a 48-year-old white man who presents with abdominal pain.

This middle-aged man comes to the ED with severe abdominal pain.


History and Physical Examination

History. History revealed the following:

The pain was sudden in onset, causing him to double over; it persisted for 24 hours. Nothing relieved or exacerbated the pain, which he described as "sharp, electric, and coming in waves," with a score of 10 out of 10 possible points on a pain scale. He had a fever to 101° F but no rigors. He also had no nausea, vomiting, diarrhea, or constipation.

  • Past medical history: obesity, non-insulin-dependent diabetes mellitus, poorly controlled (has no insurance)

  • Medications: none

  • Allergies: none

  • Habits: 3-4 beers per day, half a pack of cigarettes per day

  • Pets: cat

  • Diet: typical American diet

  • Travel: none recently; spent time in Mexico and Central America in his 20s

  • Social: single, never married, works from home as a computer programmer

  • Immunizations: up to date

  • Sports/water exposure: none

  • Infectious disease exposure: none known

Physical examination. On physical examination, the following were noted:

  • Vital signs: temperature - 101° F; pulse - 100 beats/min; respirations - 18 breaths/min; blood pressure - 180/90 mm Hg

  • General: ill appearing, in pain, somewhat groggy from pain medications

  • HEENT: normal

  • Lungs: clear

  • Heart: no rubs, gallops, or murmurs

  • Abdomen: obese, hypoactive bowel sounds, slightly tender with mild-to-moderate rebound and guarding

  • Extremities: decreased hair on shins

  • Skin: normal

  • Genitourinary: normal

  • Neurologic: oriented to person, time, and place; cranial nerves were normal; absent ankle and knee reflexes, upper extremities normal; no proprioception or vibration in legs; normal motor throughout


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