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27-year-old female nurse with lower abdominal pain for three days - Coggle…
27-year-old female nurse with lower abdominal pain for three days
Past history
PE
Abdomen
soft, tenderness over middle lower area, mild rebounding tenderness, no muscle guarding
Inspection: scaphoid
Auscultation: bowel sound normal
PI
intermittent low grade fever(37.8-38.2) for 3 days
abdominal dull pain
without shifting to flank
nausea, but no vomiting
watery diarrhea
GYN history
no vaginal bleeding nor discharge
virgin, LMP: 5/14, D/I: 5-7/30 days regular
Image
Chest PA
Normal heart size and configuration , Prominent bilateral hilar shadow , No prominent pleural effusion , Normal appearance of bony thorax
KUB
lieus(coin sign?)
CT
right side adnexa cyst,
Ileus with dilated bowel loops, cause?
A 48 mm cyst noted in right adnexa
Ascites
Fatty liver change
5.Two hypoenhanced foci noted in right lobe of liver, maybe cyst (Srs:4 Img:10,11)
Transabdominal sonography
unilocular right adnexa cyst with hypoechoic content and smooth surface.
no ascites over morrison pouch, CDS
1.acute abdomen or IAI could not rule out
2.right ovarian cyst, rupture and torsion was less likly
3.PID was less likly
4.ileus
Lab(5/22)
PT: 13.7 sec
WBC: 17600, Neutrophil seg.: 87.4
Blood culture*2
hsCRP: 19.25
Lipase<3
PH: 7.31
Lactate: 7.0(normal)
Stool routine: normal