Subjective: Age, race and PMHx

This is a 68yr old Caucasain male with PMHx of T2DM, diverticulosis, and benign brain tumor
status post resection who presents today complaining of abdominal pain.

Pain - OPQRST onset, progression, quality, radiation, severity and timing

He has had progressively worsening LLQ pain for the past 4hours rated at 9/10 at max and
currently at 5/10 in the ED right now. The pain is describes as sharp and stabbing, non-radiating
pain fixed to the LLQ. Nothing makes the pain better and its worsened with ambulation. The pt
noticed the pain began right after breakfast and has been colicky since feeling it every 30secs
lasting for 5 secs. He tried OTC tylenol and had a heat pad but it didnt help.

Pertinent ROS:

He endorses subjective fevers, nausea and decreased bowel movements but denies vomiting,
testicular pain, hematuria and bloody stools.

Med/Social:

He is well controlled on metformin and has been in the ED once before for a similar presentation
which ended up being dx as diverticulosis. He is a smoker or has etc diet.

Objective:
Vitals: ..state the trend.
Pertinent lab results: Lactic acid of 3, wbc count of 13 and glucose of 288. All other labs are
within the normal limits.

PE:
GA: On exam he appears in moderate distress.
Head: Normocephalic, atraumatic. Anterior fontanelle is flat and soft. Mucous membranes pink
and moist.
Heart: No deformities, No added sound. S1 S2 present , no murmurs, gallops, S3 or S4.
ABD: symmetrical, non-distended, non tender, (+) bowel sounds.
Skin: warm, dry, intact , cap refill <2 sec, no rash, lesion, pallor or cyanosis was noted.

Assessment : 68yr old caucasian male with PMHx of T2DM, diverticulosis and benign brain
tumor s/p resection who presents today complaining of LLQ abdominal pain.

Plan: go problem wise.. What is the pt in for..here he is in for LLQ abd pain.
LLQ abd pain: likely diverticulosis vs viral gastroenteritis vs testicular torsion vs DKA. CT scan,
repeat WBC and Lactate. ABX pending CT.

Lactic acidosis and WBC - likely diverticulosis . monitor for testicular pain
Disposition: admit to medicine floor.