Mr E arrives at his GP’s rooms in agony. Since the early hours of the morning he has had severe abdominal pain. He went out for dinner to a local seafood restaurant the night before and had a glass of wine and seafood pasta.
He is unable to lie still and vomits twice. The following is a summary of the doctor’s notes:
Sudden onset abdominal pain: started around the navel, moved down to the right lower abdomen.(Patient describes pain as dull and aching; occasional cramping)
Vomiting and nausea; no reports of diarrhoea
Smoker, and used some alcohol one day ago
No previous medical or surgical history
Patient appears to be in severe pain; restless and sweating
Patient is not dehydrated; no signs of jaundice; not pale; no enlarged lymph nodes; no signs of cyanosis (oxygen deprivation); no signs of oedema.
On inspection: no obvious swelling; no previous surgical scars; no hernias noted
On palpating the abdomen: very tender abdomen – especially in the right lower quadrant. Abdomen feels hard; guarding on palpating the abdomen
On listening for bowel sounds: present, but obviously decreased
Cardiovascular and Respiratory exam: clear, except for fast breathing and a rapid heart rate
Vital signs and side room investigations:
Heart rate: 112
Respiratory rate: 16
Finger prick blood sugar: 3.1
Urine dipsticks: clear
Based on the above information, what is your diagnosis?
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