History of Present Illness

A man in his mid-40s comes to the emergency department with a complaint of intermittent gradually worsening left lower quadrant abdominal pain over the last 5 days. The patient has no significant medical history and is taking no medications. He has no associated fever, vomiting, diarrhea, dysuria, hematuria, or other complaints. He notes that he has never had anything like this before and it seems to be getting worse each day. The patient’s wife notes that his eyes look yellow. 

Vital Signs and Physical Examination

The patient’s vital signs are normal. Physical examination is normal except for lower left quadrant tenderness with mild guarding. No noticeable jaundice is observed. Laboratory tests are normal, including uric acid (UA), liver function test including bilirubin, complete blood count (CBC), and lipase.

Because the patient has never had this pain before and it is getting worse, a computed tomography (CT) scan is ordered, even though the clinician thought it would be low yield (Figure).

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