Download (-) abdominal pain

Colorectal Surgery
Tindoc, Tugano, Urquiza, Uy, Velasco,
Ventigan, Ventura, Verdolaga
Patient Profile
• M.Y., 35/M
• Married, Roman Catholic, from Camarines
Norte
• Chief complaint: abdominal pain
History of Present Illness
3 months PTA
(+) Crampy abdominal pain
• Lasts for a few seconds, every 2-3 minutes
• VAS 5/10, diffuse
• Not related to food intake
History of Present Illness
• (-) changes in appetite, bowel movement, quality
of stools
• (-) tenesmus
• (-) vomiting, fever, jaundice
• Consulted a local hospital  prescribed with
Motilium, 3 tabs for 1 day relieved
History of Present Illness
2 months PTA
– Abdominal pain recurred
• VAS 7/10
• Similar quality
– No other symptoms
– Took Motilium and Buscopan  relieved
History of Present Illness
1 month PTA
– (+) abdominal pain – diffuse, crampy, VAS
5/10
– (+) bloated sensation
– Given unrecalled medication  no relief
History of Present Illness
– Pain progressed the following day
• VAS 10/10
• Hospital  given unrecalled IV meds  relieved
• Abdominal UTZ & Xray – allegedly showed
abdominal mass
• Biopsy – well-differentiated adenocarcinoma
History of Present Illness
1 week PTA
– PGH-ER
• for abdominal pain, VAS 8/10
• (-) other symptoms
• (+) palpable mass, RLQ
– Admitted for surgery
Review of Systems
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(+) good appetite
(-) weight change
(-) jaundice
(-) hematemesis
(-) diarrhea
(-) constipation
(-) difficulty in defecation
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(-) abdominal pain
(-) melena
(-) hematochezia
(-) tenesmus
(-) change in caliber of
stool
• (+) good urine output
Past Medical History
• (-) HPN, DM, PTB, bronchial asthma
• (-) known allergies
• (-) previous hospitalizations/surgeries
Family Medical History
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(+) GI cancer – maternal grandfather
(+) Brain cancer – maternal uncle
(+) Ovarian cancer – mother
(+) thyroid disease – paternal side
(-) HPN, DM, PTB, asthma
Personal Social History
• (+) 2-pack year smoker, stopped 14 years
ago
• (+) occasional alcoholic beverage drinker,
consuming 3-5 bottles of beer
• Denies illicit drug use
• Used to work as a videographer in a ship
• Diet: mostly meat; fond of grilled food
Physical Exam
General Survey alert, coherent, ambulatory, not in cardiorespiratory distress
Vital Signs
BP 120/70 HR 72
RR 20
Temp 36.7
HEENT:
Chest/Lungs:
CVS:
anicteric sclerae, pink conjunctivae, (-) CLAD, (-) NVE, (-)
neck mass
equal chest expansion, clear breath sounds, (-)
crackles/wheezes
adynamic precordium, distinct S1 and S2, normal rate,
regular rhythm,
(-) murmurs, (-) heaves/thrills
Physical Exam
Abdomen
soft, normoactive bowel sounds
(-) tenderness on deep and light palpation
non-distended,
(+)palpable mass on RLQ
(-)Psoas, (-) obturator, (-) Rovsing’s
DRE
good sphincter tone, smooth rectal mucosa, intact
rectal vault (-) masses (-)pararectal tenderness, ()blood per examining finger
Skin/Extremities full and equal pulses, pink nail beds, good CRT, (-)
clubbing, cyanosis, edema