Emergency Medicine: Abdominal Pain Evaluation

Patient Presentation

• 20-year-old woman presenting to the emergency department with abdominal pain
• Gradual onset of pain 24 hours prior, persistent in the lower abdomen

Medical History

• No diarrhea or abnormal urinary symptoms
• Last menstrual period 12 days prior, no abnormal pattern in menses
• Sexually active with one partner
• Unremarkable past medical and surgical history
• Takes no medications, consumes alcohol socially

Physical Examination

• Temperature: 38.2°C (100.8°F)
• Blood pressure, pulse rate, and respiratory rate: normal
• Cardiopulmonary examination: unremarkable
• Abdomen: soft, nondistended, tender to palpation in suprapubic and right lower quadrant
• No peritonitis or masses detected
• Bowel sounds: hypoactive
• Rectal examination: unremarkable

Pelvic Examination

• No purulent discharge
• Tenderness in the right adnexal region

Laboratory Studies

• White blood cell count: 14,000/mm3
• Hemoglobin and hematocrit values: normal
• Serum electrolyte and amylase levels: normal
• Urinalysis:
  • Concentrated urine
  • 3 to 5 red blood cells per high-power field
  • 3 to 5 white blood cells per high power field
  • Negative for leukocyte esterase
• Serum pregnancy test: negative

A young woman presents to the emergency department with persistent abdominal pain. Evaluate her symptoms and medical history to determine the cause of her pain.