Case #69 "The Hot Engineer"
by Charlene Babcock Irvin, MD, FACEP
A resident approaches you regarding a
patient he has just seen. She is a 22 y/o
female that presents with right-sided
abdominal pain and a fever. She has had this
pain for two days, progressively getting
worse. The fever started yesterday. The side
pain is on her RUQ area, described as an
aching and throbbing type of pain. No other
abdominal pain. No vaginal discharge. No
dysuria or frequency. No hemeturia. No
vomiting, but she does have some nausea. The
pain does not change with food.
PMH: Negative G0P0, no previous
hospitalizations. No history of STD’s. No
surgeries.
SH: She recently started her job as an
engineer
FH: Negative
ROS: Fevers as noted. Headaches with fevers,
gets better with ibuprofen. No neck pain,
sore throat, cough, chest or abd. pain. No
rashes. All other ROS negative.
PE: Temp = 102.8, RR=20, BP=133/82 P=120
WDWN female, appears slightly pale, but in
no acute distress.
HEENT: Normal. No jaundice
HEART: Tachycardic
LUNGS: Clear, no wheezing
ABD: Diffuse mild tenderness to RUQ area. No
masses. No guarding or rigidity. Overall,
abdominal exam is not very impressive.
Bi manual Pelvic: No cervical motion
tenderness. Non-tender uterus/ovaries. No
masses.
Rectal: Guiac negative
EXT: Normal, no rashes.
He wants to get an ultrasound and work her
up for possible cholicystitis or liver
abscess.
1. How likely is it that she has acute
cholicystitis? What is a more likely cause
of fever in this age group with this
presentation?
2. What are the markers of serious bacterial
illness in adults presenting to the ED with
fevers?
3. A lab test confirms your suspicion. How
will you treat it? What are the indications
for admission?
4. Should you get a blood culture?
5. In children, how common is this?
6. Any other discharge instructions?
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