A Common Condition with an Uncommon Presentation

​BY ARJUN BHARAD​WAJ​ & AHMED RAZIUDDIN, MD​A 41-year-old man who recently immigrated from Africa came to the ED with abdominal pain. The patient primarily spoke Tigrinya, and an interpreter was used in taking a history. The patient's abdominal pain had started four hours earlier, which he described as squeezing or cramping mid-epigastric and umbilical pain. The pain did not change or radiate.He had also had three episodes of nonbloody emesis. This was a new problem for him, and he hadn't encountered anyone sick or with similar symptoms. His last bowel movement was the previous night, and no changes in bowel or urination were noted. He had no fever, chills, chest pain, shortness of breath, weakness, or fatigue. He had leftover food the night before, and he drank lemon juice to calm his stomach that morning. He had no past medical or surgical history but a family history of hypertension on his father's side.Mild tenderness in the epigastric and umbilical regions, normoactive bowel sounds, fullness in the epigastric region, and no abdominal guarding or rigidity were noted on exam. There was no McBurney's point tenderness, rebound tenderness (Blumberg's sign), Murphy's sign, Rovsing's sign, Dunphy's sign, psoas sign, no percussive tenderness, or obturator sign. The history and physical exam indicated a likelihood of viral gastritis, but other possibilities such as gastroesophageal reflux disease, gastric/intestinal ulcers, pancreatitis, gall bladder-associated diseas...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research