Recurrent Abdominal Pain .

A 51-year-old woman presents to an outpatient surgical consultation for abdominal pain. She first noted the pain 9 months ago. She states that the pain occurs about every 3-4 weeks, and that each episode lasts 2-3 days at a time. The pain is described as “excruciating” when it occurs, causing her to double over, and it is diffuse across the abdomen. There is severe nausea associated with the pain, but there have been no episodes of emesis. She cannot cite any alleviating or aggravating factors. The pain does not improve after a bowel movement, and there have been no changes in her bowel habits. The pain has not affected her appetite, and she denies having any fever, chills, melena, or hematochezia. She has not experienced any recent weight loss. Her past medical history is significant for gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), bilateral ovarian cysts, and depression. Her medications include esomeprazole, aspirin, bupropion, and alprazolam, as needed. She is also taking acetaminophen/hydrocodone as needed for abdominal pain. The patient’s past surgical history is significant for a vaginal hysterectomy remotely. The family and social histories are noncontributory. The patient notes that over the course of the past 9 months, she has had a computed tomography (CT) scan of the abdomen and pelvis, as well as undergone a colonoscopy; the results of both studies were entirely unremarkable (except for the previously diagnosed ovarian cysts).

The physical examination reveals a mildly overweight white female in no acute distress. Her weight is 190 lb (86 kg) and her height is 5’5″ (165 cm). The patient’s body mass index (BMI) is 31.6 (Obesity Class I). Her oral temperature is 98.4°F (36.9°C). Her blood pressure is 138/88 mm Hg, her pulse is regular at 75 bpm, and her heart sounds are normal, without any murmurs, rubs, or gallops. The patient’s respirations are 14 breaths/min and unlabored, and her lungs are clear to auscultation. Examination of the head and neck is entirely unremarkable. Her abdominal examination reveals a nontender and nondistended abdomen, with normal bowel sounds. There is no rebound, rigidity, or guarding, and no discrete masses are palpated. A rectal examination is not performed. The extremities exhibit normal range of motion, and no clubbing, cyanosis, or edema is observed.

The patient states that several days before this visit for surgical consultation, she felt the abdominal pain returning and went to the emergency department (ED) to be examined during the episode. The laboratory analysis performed at that time, which included a urinalysis, complete blood cell (CBC) count with differential, complete metabolic panel, amylase, and lipase, is entirely within normal limits. A repeat abdominal and pelvic CT scan had been performed during the recent ED visit, and she was told that the preliminary interpretation was “normal.” She has brought the official interpretation of her CT scan as well as the films themselves.

What is ur diagnosis??????????

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Filed Under: Discussion • GI

Tags: abdominal pain, bilateral ovarian cysts, depression, excruciating, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS)