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The ambiguous abdomen in a basic military trainee

The ambiguous abdomen in a basic military trainee A DIFFICULT DIAGNOSIS The ambiguous abdomen in a basic military trainee Timothy J. Bonjour, DSc, MPAS, PA-C CASE A 21-year-old Hispanic man in basic military training presented to the ED via ambulance for a 2-week history of worsening right-sided abdominal pain, worsening nau- sea, and vomiting. History The patient localized his area of concern to just inferior to his right upper quadrant, extending to the region of his right anterior superior iliac spine. He denied fever, chills, diarrhea, hematemesis, hematochezia, nonsteroidal anti-infl ammatory use, weight loss, recent foreign travel, or known ill contacts. Ten days ago, he was seen in the outpatient setting and had an acute abdominal radiograph series, which demon- strated a faint 2-mm calcifi cation projecting over the expected location of the right kidney. This may have represented a nephrolith or artifact. He was counseled on return precautions and started on a stool softener for likely constipation-related pain, which is common in basic train- ees because of abrupt dietary changes. His past medical, surgical, and family history were noncontributory; immu- FIGURE 1. CT fi ndings in BCS: Axial CT image with subacute BCS nizations were current; he reported no known drug aller- shows thrombosis of main http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the American Academy of Physician Assistants Wolters Kluwer Health

The ambiguous abdomen in a basic military trainee

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2021 American Academy of Physician Assistants
ISSN
1547-1896
eISSN
0893-7400
DOI
10.1097/01.jaa.0000791496.19639.01
Publisher site
See Article on Publisher Site

Abstract

A DIFFICULT DIAGNOSIS The ambiguous abdomen in a basic military trainee Timothy J. Bonjour, DSc, MPAS, PA-C CASE A 21-year-old Hispanic man in basic military training presented to the ED via ambulance for a 2-week history of worsening right-sided abdominal pain, worsening nau- sea, and vomiting. History The patient localized his area of concern to just inferior to his right upper quadrant, extending to the region of his right anterior superior iliac spine. He denied fever, chills, diarrhea, hematemesis, hematochezia, nonsteroidal anti-infl ammatory use, weight loss, recent foreign travel, or known ill contacts. Ten days ago, he was seen in the outpatient setting and had an acute abdominal radiograph series, which demon- strated a faint 2-mm calcifi cation projecting over the expected location of the right kidney. This may have represented a nephrolith or artifact. He was counseled on return precautions and started on a stool softener for likely constipation-related pain, which is common in basic train- ees because of abrupt dietary changes. His past medical, surgical, and family history were noncontributory; immu- FIGURE 1. CT fi ndings in BCS: Axial CT image with subacute BCS nizations were current; he reported no known drug aller- shows thrombosis of main

Journal

Journal of the American Academy of Physician AssistantsWolters Kluwer Health

Published: Oct 1, 2021

References