In the ED, their vitals/exam are as above. The differential for the patient’s symptoms is very broad and includes diverticulosis, diverticulitis, colitis, enteritis, pancreatitis, pancreatic ulcer, peptic ulcer disease (including perforated ulcer), epigastric hernia, gastroesophageal reflux disease, gastritis, gastropathy, esophageal spasm, functional dyspepsia, gastroparesis, intestinal obstruction +/- colon cancer, biliary colic, acute cholecystitis, acute cholangitis, acute hepatitis, early appendicitis, splenic pathology, urinary tract infection/cystitis, nephrolithiasis, pyelonephritis, inguinal hernia, abdominal aneurysm, or mesenteric ischemia/ischemic colitis. Referred symptoms from myocardial infarction or pulmonary disease are also on the differential, albeit less likely. COVID-19 infection is also on the differential. Although patient’s abdominal exam is somewhat reassuring, given the patient’s age and history, will proceed as below.
– Labs/Tests: Lactate, CBC, CMP, Lipase, PT/INR, UA w/ reflex UCx, COVID-19 RT PCR
– Imaging: CTAP (consider CTA if concerned for mesenteric ischemia/ischemic colitis)
– Treatments: IVF/antiemetics/pain control as needed
– Consults: None
– Dispo: Pending further testing