"you have a 16 y/o african american female in room 18 complaining of abdominal pain. Her mother is here with her".
What could it be? One thing is for sure, she has to be in some pretty good pain to get her mom to drive her here on a Friday night. Abdominal pain in a female could mean a lot of things. We call this a differential diagnosis, which basically means listing out everything it could possibly be. A few possibilities = gastroenteritis gastric ulcer, duodenal ulcer, GERD, Barrett's Esophagus, Mallory-Weis syndrome, Boerhaave Syndrome, Gall bladder disease, kidney stones, appendicitis, diverticulitis, diverticulosis, ovarian cysts, endometriosis, ovarian torsion, pelvic inflammatory disease (PID), ectopic pregnancy. This by no means is a complete list but a few of the things that went through my mind as I contemplated this patient.
Each of these disease states will have different clues to help guide you but you can never be too sure. There is always the atypical presentation. For example if you suspect an ulcer one way to narrow down the location of the ulcer is to find out when it hurts, duodenal ulcers = the pain is relieved by eating but in gastric ulcers the pain is made worse by eating. Usually through asking some questions and doing a physical exam we can narrow the diagnosis down to a few things and the hopefully through imaging studies and labs finally nail down the diagnosis.
I went in to see the young girl and started to ask a few questions when I realized I would not get too far with her mom in the room. So I told her mom to head for the hills, beat it, scram, etc. Once mom was gone the patient started to cry and said I think that I am pregnant. On physical exam I found that she did have bilateral pain in the lower abdomen / groin area. I knew that she would be needing a pelvic. I asked a few more questions and had the nurse get her urine and some blood to run some labs. My attending and I went back in with a female nurse chaperone and I did the pelvic. I will spare you the nastiness that ensued. It turns out our patient had PID. She was not pregnant.
I spent a lot of time answering the girl's questions and trying to scare her to think twice about unprotected sex. Her pregnancy test was negative. We treated her PID and sent her home.
As she was leaving a nurse told me that I had a patient who had overdosed in room 20.
Welcome to the ER on a Friday night. My shift had just begun....
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