Pain Abdomen

Apurva Shrestha
Aampipal
Patient Particulars

• Name: Indra Gharti

• Age: 25 years/ Female

• Occupation: Homemaker

• Religion: Hindu

• Marital status: Married

• Address: Palungtar

• Chief Complain: Lower abdominal pain for 2 days

History Of Presenting Illness

• Bilateral back pain radiating towards lower abdomen region

• Max pain in the right lower abdomen region

• Pain: continuous, pricking in nature, aggravated by movement and

a/w nausea, frequency, nocturia for 3-4 nights.

• No history of fever, vomiting, headache, LOA, burning micturition,

loose stool or vaginal discharge

• No history of acid reflux, water brash or abdominal distention

Past Medical history
• She was diagnosed of cystitis 1week ago for which she was given

Tab. Ciprofloxacin 500mg bd

Tab. Pantoprazole 40 mg od

• She also had 2 episodes of similar presentation of abdominal pain in the iliac
region. Last episode being 1 month back for which she was diagnosed as non-
specific abdominal pain

• She has no history of Hypertension, DM, TB or thyroid disorders.

• No history of surgical interventions

Menstrual history

• LMP: 28th Bhadra 2076

• Regular, lasting for 3-4 days

• No history of passage of clots, dysmenorrhea, intermenstrual bleed

• OBS: P3L3A0
• Drug history: No history of any drug intake

• Family history: No history of Hypertension, DM, COPD, TB

• Personal History: She is a non-smoker and doesn’t consume alcohol

Examination
• General Physical Examination:
She was moderately built, lying in bed and well oriented to time,
place and person and had an IV canula in the dorsum of her right
hand.

• Vitals:
• Pulse: 63/min, regular, normal volume
• BP: 110/ 70 mmHg in left arm
• RR: 23/min
• Temp: afebrile
• P/A:

• Inspection: Normal in shape, all quadrants moving equally with respiration,

umbilicus centrally placed and inverted. No visible scar marks, dilated veins,
pigmentation or visible peristalsis. Hernia orifices were intact.

• Palpation: No superficial rise in temperature. Tenderness present all over

the lower quadrant. Max tenderness on the right side, Positive Rovsing sign.
Rebound tenderness present. Psoas and obturator sign absent. No palpable
organ
• Percussion: Tympanic all over the abdomen, No shifting dullness, No renal angle
tenderness.

• Auscultation: Bowel sound present.

• M:0

• A:0

• N:1

• T:2

• R:1

• E:0

• L:2
• Chest: B/L equal air entry, NVBS, no added sound

• CVS: S1S2M0
Differentials

• Appendicitis

• Pelvic inflammatory disease

• Pyelonephritis

• Ovarian cyst

• Fibroid

• Ureteric colic
Investigations
• WBC: 12800
• P:79, L:14, M:04, E:03
• Urine RME:
• Sugar: -ve
• Albumin: Nil
• Leucocyte esterase: Neg
• Nitrate: Neg
• RBC: 1-2/hpf
• Pus cell: 2/hpf
• Epithelial cells: 3-5/ hpf
• UPT: negative
• USG: B/L ovarian cyst.

• Diagnosis: B/L ovarian cyst

• Management
• IV Fluids
• Tab. Buscopan 10mg
• Referral to Patan hospital
• The availability of USG helped differentiate the cause as presence of
ovarian cyst rather than the appendicitis as the history and
examination presented.
Socio-cultural factors

• Health insurance

• Accessibility
Reflection

• We should always have a broader approach to any presentation even

in presence of typical features.

• Helped revise the approach of pain abdomen.

THANK YOU