Gastro Case Challenge: Excruciating Abdominal Pain in a Woman Taking Benzodiazepines and Narcotics

Noah Gudel, DO; Lisa M. Rock, MD


December 07, 2022

Physical Examination and Workup

The physical examination reveals an overweight white woman in no acute distress. Her weight is 190 lb (86.2 kg), and her height is 5'5" (1.65 m). Her body mass index is 31.6.

The patient's oral temperature is 98.4°F (36.9°C). Her blood pressure is 138/88 mm Hg; her pulse is regular, at 75 beats/min; and her heart sounds are normal, without any murmurs, rubs, or gallops. The patient's respirations are 14 breaths/min and unlabored, and her lungs are clear to auscultation.

Examination of the head and neck is unremarkable. Abdominal examination reveals a nontender and nondistended abdomen, with normal bowel sounds. No rebound, rigidity, or guarding is noted, and no masses are palpated. A rectal examination is not performed. The extremities exhibit normal range of motion, and no clubbing, cyanosis, or edema is observed.

The patient states that several days prior, she had an episode of pain and went to the emergency department (ED) to be examined. Laboratory analysis included urinalysis, complete blood cell count with differential, complete metabolic panel, amylase, and lipase; all values were within normal limits. Abdominal and pelvic CT were repeated during the recent ED visit, and she was told that the preliminary interpretation was "normal." She has brought the official interpretation of her CT scan as well as the films themselves (Figures 1 and 2).

Figure 1.

Figure 2.


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