BLOK DIGESTIVE 2021/2022

STUDENT’S GUIDE

Sharp and Colicky Abdominal Pain

Mrs. J was a 44-year-old female who presented to emergency department with an acute
onset of upper abdominal pain experienced for 3 days. The pain originated in umbilical region then
radiated to lower right abdomen region. The pain was of sudden onset, sharp with progressing
intensity. She took paracetamol 500 mg before presenting to hospital, which did not relieve the
pain. The pain was exacerbated by lifting the right leg and relieved by leaning forwards. Severity
was rated nine on a scale of 1 to 10, with 1 being no pain and 10 being the most pain possible. The
pain was associated with few episodes of nausea, vomiting, fever and constipation. She had never
experienced this complaint before. She denied disuria. There was no significant past medical
history before. There was no relevant family history.
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On clinical examination, she had a body temperature of 38.8 C, her pulse was 110
beats/min, her blood pressure was 130/90 mmHg. The abdominal examination revealed a soft
abdomen, The right hypochondrium and right lumbar areas were tender on percussion, with
moderate tenderness in the other quadrants, and a positive psoas sign. Rovsing's sign (+) and absent
hernias.
The laboratorium test result, the complete blood count showed leukocytosis-a white blood
count of 18 x 109 cells/L. All other investigations were normal (a negative urine dip and negative
pregnancy test). Abdominal ultrasonography confirmed diagnosis by the presence of free fluid
within the RIF (Right Illiac Fossa) and within the 6mm appendix which was incompressible. After
initial management with intravenous (IV) fluids, analgesic and antibiotics, the patient was referred
to Surgery Department for further management. The doctor in Surgical Department asked the
patient to sign an informed-consent letter.

Please discuss the scenario above.

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