What is the appropriate management for a 17-year-old female presenting with abdominal pain, without fever or diarrhea, and a history of daily marijuana (cannabis) use?

SOAP Note Questions for 17-Year-Old Female with Abdominal Pain and Cannabis Use

For a 17-year-old female with abdominal pain and daily cannabis use, the most appropriate management approach is to perform a CT scan of the abdomen and pelvis with IV contrast to rule out serious pathology, while also considering cannabinoid hyperemesis syndrome as a potential diagnosis. 1

Subjective Questions (History)

• Characterize the abdominal pain:

  • Location: Is the pain localized or diffuse? 1
  • Onset: When did it start exactly and was it sudden or gradual? 1
  • Duration: Has it been constant or intermittent over the past day? 1
  • Quality: Sharp, dull, cramping, burning? 1
  • Severity: On a scale of 1-10, how would you rate the pain? 1
  • Radiation: Does the pain spread to other areas? 1

• Associated symptoms:

  • Any nausea or vomiting? If yes, does taking hot showers relieve symptoms? 2, 3
  • Any changes in appetite? 3
  • Any changes in bowel habits (constipation or diarrhea)? 1
  • Any urinary symptoms besides voiding without pain? 1
  • Any menstrual history and last menstrual period? 4
  • Any sexual activity and possibility of pregnancy? 4

• Cannabis use details:

  • How long have you been using cannabis? 2, 3
  • Has your cannabis consumption increased recently? 2
  • Have you experienced similar symptoms before? 3
  • Have you noticed any relationship between cannabis use and symptoms? 2

• Medical and surgical history:

  • Any previous abdominal surgeries? 1
  • Any history of gastrointestinal disorders? 1
  • Any previous similar episodes? 3
  • Any chronic medical conditions? 1

• Medication history:

  • Any current medications? 1
  • Any recent antibiotic use? 1
  • Any over-the-counter medications taken for the pain? 1

Objective Questions (Physical Examination)

• Abdominal examination:

  • Location of tenderness (quadrant-specific or diffuse)? 1
  • Presence of rebound tenderness or guarding? 1
  • Any abdominal distension? 1
  • Bowel sounds (normal, hyperactive, hypoactive)? 5

• Other physical examination:

  • Any signs of dehydration? 1, 3
  • Any jaundice? 1
  • Any skin rashes or lesions? 5
  • Any lymphadenopathy? 5

Assessment Questions (Diagnostic Considerations)

• Laboratory tests to consider:

  • Complete blood count to check for leukocytosis 1
  • Comprehensive metabolic panel 3
  • Urinalysis 1
  • Pregnancy test 4
  • Urine toxicology screen 3
  • Lipase and amylase levels 1

• Imaging considerations:

  • CT abdomen and pelvis with IV contrast 1
  • Ultrasound if pregnancy is suspected 1

• Differential diagnosis to consider:

  • Cannabinoid hyperemesis syndrome 2, 3
  • Appendicitis 1
  • Cholecystitis 1
  • Gastroenteritis 3
  • Inflammatory bowel disease 1
  • Pelvic inflammatory disease 4
  • Ovarian pathology 4
  • Pancreatitis 1
  • Urinary tract infection 1

Plan Questions (Management)

• Immediate management:

  • IV fluid rehydration if signs of dehydration 1
  • Antiemetics if nausea/vomiting present 3
  • Pain management options 1

• Diagnostic plan:

  • CT abdomen and pelvis with IV contrast as the primary imaging modality 1
  • Laboratory tests as indicated above 1

• Treatment considerations:

  • If cannabinoid hyperemesis syndrome is suspected, discuss cannabis cessation 2, 3
  • Specific treatment based on identified pathology 1
  • If no organic cause is found, consider functional abdominal pain 1

• Follow-up plan:

  • Timeframe for follow-up appointment 1
  • Indications for returning to emergency care 1
  • Substance use counseling referral 3
  • Mental health evaluation if indicated 1