What is a case study of a patient presenting with abdominal pain?

From the Guidelines

A 35-year-old female presented to the emergency department with severe abdominal pain, nausea, and vomiting, and was diagnosed with acute appendicitis after a CT scan of the abdomen and pelvis, which is the most appropriate imaging modality for evaluating patients with nonspecific abdominal pain, as it has a high diagnostic yield for detection of appendicitis and other causes of abdominal pain 1.

Patient Presentation

The patient had a 2-day history of abdominal pain that started as periumbilical discomfort and gradually localized to the right lower quadrant, accompanied by nausea, vomiting, and a low-grade fever.

• Physical examination revealed rebound tenderness at McBurney's point, guarding, and a positive Rovsing's sign.
• Laboratory tests showed leukocytosis with a white blood cell count of 12,000/μL and elevated C-reactive protein at 2.5 mg/dL.

Diagnosis and Management

• Abdominal CT scan confirmed the diagnosis of acute appendicitis, showing an enlarged appendix (10mm diameter) with wall thickening and surrounding inflammatory changes.
• The patient underwent laparoscopic appendectomy and received perioperative antibiotics including cefazolin 2g IV before surgery and continued with ceftriaxone 1g IV daily and metronidazole 500mg IV every 8 hours for 48 hours post-surgery.
• The use of CT scans in the diagnosis of acute appendicitis has been shown to have a high sensitivity and specificity, with a summary sensitivity of 95% and summary specificity of 94% 1.

Outcome

The patient's pain resolved following surgery, and she was discharged on day 3 with oral amoxicillin-clavulanate 875/125mg twice daily for 5 days.

• The patient's outcome is consistent with the findings of a recent study, which showed that CT scans can help reduce the negative appendectomy rate and improve patient outcomes 1.
• The use of CT scans in the diagnosis of acute appendicitis is supported by the American College of Radiology, which recommends CT scans as the initial imaging modality for evaluating patients with nonspecific abdominal pain 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Case Study of a Patient Presenting with Abdominal Pain

• A patient presenting with abdominal pain can have a variety of underlying causes, ranging from life-threatening to benign conditions 2, 3, 4, 5, 6
• The location of the pain is a useful starting point for evaluation, with right lower quadrant pain suggesting appendicitis, and right upper quadrant pain suggesting cholecystitis or other hepatobiliary diseases 4, 5
• A systematic approach to evaluating patients with abdominal pain is essential to generate a differential diagnosis and ensure appropriate treatment 2, 3
• The evaluation of acute abdominal pain requires consideration of patient history, physical examination, laboratory tests, and imaging studies 4, 5
• Special populations, such as women and the elderly, may present with atypical symptoms or require special consideration in the evaluation of abdominal pain 4, 5

Common Causes of Abdominal Pain

• Gastroenteritis and nonspecific abdominal pain are common causes of acute abdominal pain in adults 5
• Other common causes include cholelithiasis, urolithiasis, diverticulitis, and appendicitis 5
• Extra-abdominal causes, such as respiratory infections and abdominal wall pain, should also be considered 5

Evaluation and Diagnosis

• Pain location, history, and examination findings help guide the workup after ensuring hemodynamic stability 5
• Recommended tests may include a complete blood count, C-reactive protein, hepatobiliary markers, electrolytes, creatinine, glucose, urinalysis, lipase, and pregnancy testing 5
• Imaging studies, such as computed tomography and ultrasonography, are chosen based on the location of pain and index of suspicion for specific etiologies 4, 5