Mrs. G.B. is a 38 year old female who presents to the emergency department with complaints of severe abdominal pain. G.B reports that she has had similar pain intermittently over the past week, however, tonight her pain has become constant and unbearable. She reports that the pain usually starts on the right side of her abdomen and radiates to her back. The pain makes it hard to take deep breaths and often occurs at night after eating dinner. G.B’s pain prevents her from sleeping and usually lasts several hours. She reports nausea but no vomiting with her pain tonight, and explains that she has taken ibuprofen and antacids but neither have helped her symptoms.
Physical Exam
Upon exam, G.B.’s vitals are found to be as follows:
HR: 106
RR: 16
BP: 148/95
Temp: 38.1 c (100.6 F)
G.B. appears uncomfortable and is sweating. G.B. reports it feels better for her to lie in bed and not move. When G.B. is assessed, the right side of her abdomen below her rib cage is palpated during inspiration. She reports increased pain to the point that she gently pushes the examiner’s hands away.
Pertinent Laboratory Tests
Abnormal Laboratory Values
- WBC – 15.4
- CRP – 18.3
Normal Laboratory Values
- Hgb, Hct, Platelets
- AST, ALT, ALP, GGT
- Amylase, Lipase
- serum HCG – not present
Past Medical History
- Obesity, patient with a BMI of 31
- Mother of 2 children, ages 3 and 5 years
- Gestational diabetes with both pregnancies
- Hypertension, diagnosed 1 year ago, mild and not treated with medication at this time
- Cesarean section, age 35 and 33
Pertinent Family History
- Father alive and healthy age 71
- Mother with a history of obesity, hypertension, and gallstones, alive age 70
- Brother with a history of obesity, alive age 41
- Sister alive and healthy age 36
Pertinent Social History
- Patient works for a local hospital doing IT assistance, has worked there for 10 years
- Patient’s hobbies include reading, knitting, and baking
- Patient reports difficulty with attempts at weight loss, prefers to not go to the gym or be seen working out in public environment
Images used in “Cholecystitis Patient Presentation” video:
Figure 1. Abdominal Pain. (Johns, C., 2018)
Figure 2. Examination of Abdomen. (Kappan, S., 2018)