A 22-year-old woman presents in the ER after 48 hours of severe (9/10), aching, diffuse abdominal pain.
Patient characteristics and history
- In past 2 years reports recurrent episodes of severe abdominal pain. Has undergone cholecystectomy, appendectomy, and total abdominal hysterectomy (without salpingo-oophorectomy), all in an attempt to localize and eliminate her recurrent abdominal pain (records and pathological diagnosis not available to ER).
- Along with episodes of abdominal pain, has nausea (no vomiting) and decreased appetite.
- Had uncomplicated cystitis 1 week prior and is now completing a course of trimethoprim/sulfamethoxazole.
- Diagnosed with major depressive disorder 3 years ago.
- Has received analgesics and opioids from multiple providers over the last 3 years.
- Takes no medications regularly, no herbal supplements, no OTC drugs.
- Lives with boyfriend in a monogamous relationship for last 3 years.
- Drinks 1-2 alcoholic beverages weekly.
- Has smoked a half a pack of cigarettes daily for last 7 years.
- Menarche at age 13, never been pregnant, never been treated for STD.
- Unknown family medical history (she was adopted).