Harbor Macros: Abdominal Pain
Abdominal Pain NO CT
This patient presents with abdominal pain of unclear etiology. Their evaluation has not identified a emergent etiology for the abdominal pain. Specifically, given the very benign exam, normal laboratory studies, and lack of significant risk factors, I have a very low suspicion for appendicitis, ischemic bowel, bowel perforation, or any other life threatening disease. I have discussed with the patient the level of uncertainty with undifferentiated abdominal pain and clearly explained the need to follow-up as noted on the discharge instructions, or return to the Emergency Department immediately if the pain worsens, develops fever, persistent and uncontrollable vomiting, or for any new symptoms or concerns. I discussed with the patient that this presentation today for abdominal pain could represent a significant risk for an acute abdominal process. Although the tests in the ED were essentially normal, there is still a possibility of a process such as appendicitis, diverticulitis, cholecystitis, ulcer, early bowel obstruction, mesenteric ischemia, kidney stone, or even kidney infection which could subsequently cause disability or death. The patient understands that they must return within 24 hours for a recheck or see their physician within 24 hours for re-exam due to the possibility of significant surgical or medical process.
Abdominal Pain with CT
This patient presents with abdominal pain of unclear etiology. A CT scan was performed to evaluate for potential causes of the abdominal pain, however, neither the clinical exam nor the CT has identified an emergent etiology for the abdominal pain. Specifically, given the benign exam, the laboratory studies, and unremarkable CT, I have a very low suspicion for appendicitis, ischemic bowel, bowel perforation, or any other life threatening disease. I have discussed with the patient the level of uncertainty with undifferentiated abdominal pain and clearly explained the need to follow-up as noted on the discharge instructions, or return to the Emergency Department immediately if the pain worsens, develops fever, persistent and uncontrollable vomiting, or for any new symptoms or concerns.
Alternative
yo M presenting with abdominal pain. Considered causes of abdominal pain that are not gender-specific (e.g., appendicitis, volvulus, small bowel obstruction, mesenteric adenitis, acute cholecystitis/choledocholithiasis, AAA and other biliary pathology, etc.) as well as male-specific causes (testicular torsion, epididymitis, orchitis, etc.). Patient well-appearing with normal vital signs. Laboratory testing and imaging here reviewed and normal. Patient given strict return precautions for worsening pain, inability to eat/drink, fevers (temperature over 100.4F), or other concerns. Patient instructed to follow up with their primary doctor and is agreeable; all questions were answered.
