Abdomen
CASE 5: ACUTE ABDOMINAL PAIN
History
A 56-year-old woman presents to the emergency department complaining of abdominal
pain. Twenty-four hours previously she developed a continuous pain in the upper
abdomen which has become progressively more severe. The pain radiates into the back.
She feels nauseated and alternately hot and cold. Her past medical history is notable for a
duodenal ulcer which was successfully treated with Helicobactereradication therapy
5 years earlier. She smokes 15 cigarettes a day, and shares a bottle of wine each evening
with her husband.
Examination
The patient looks unwell and dehydrated. She weighs 115 kg. She is febrile, 38.5°C, her
pulse is 108/min and blood pressure 124/76 mmHg. Cardiovascular and respiratory system
examination is normal. She is tender in the right upper quadrant and epigastrium, with
guarding and rebound tenderness. Bowel sounds are sparse.
A plain abdominal X-ray is shown in Fig. 5.1.
NormalHaemoglobin 14.7 g/dL 11.7–15.7 g/dL
White cell count 19.8% 109 /L 3.5–11.0% 109 /L
Platelets 239 % 109 /L 150–440% 109 /L
Sodium 137 mmol/L 135–145 mmol/L
Potassium 4.8 mmol/L 3.5–5.0 mmol/L
Urea 8.6 mmol/L 2.5–6.7 mmol/L
Creatinine 116 &mol/L 70–120&mol/L
Bilirubin 19 &mol/L 3–17&mol/L
Alkaline phosphatase 58 IU/L 30–300 IU/L
Alanine aminotransferase (AAT) 67 IU/L 5–35 IU/L
Gamma-glutamyl transpeptidase 72 IU/L 11–51 IU/L
C-reactive protein (CRP) 256 mg/L !5 mg/L