Episode-25: A patient with left lower quadrant pain

A patient with left lower quadrant pain.

If a patient presents with left lower quadrant pain, one should consider following differential diagnoses considering site such as

Irritable bowel syndrome

Salphingitis

Inguinal hernia

Ectopic pregnancy

Uterolithiasis

Inflammatory bowel disease

Diverticulitis

A patient presenting with left iliac fossa pain.

A 25 years old married lady presented with severe pain in the left iliac fossa for 6 hours. She gives history of amenorrhoea for one and half months.

What are the diagnoses striking in your mind?

What key questions would you ask?

Pain-

Constant pain in left iliac fossa and suprapubic region salphingitis or ectopic pregnancy.
Colicky loin pain radiates to groin, labium and inner side of thigh, vomiting, dysuria and haematuria- ureteric stone

Menustral history- a history of missed period suggestive of ectopic

pregnancy.

What would you examine?

General examination-

Distressed with pain.
Pulse may be thready and BP low if intraperitoneal bleeding from ectopic pregnancy.

Abdominal examination-

Severe tenderness in left iliac fossa and suprapubic region, may be diffuse tenderness later on- ectopic pregnancy.
- Mild to moderate tenderness in salphingitis.
- Normal abdominal examination in ureteric stone.

Clinical diagnosis–

Severe left iliac fossa pain and tenderness with history of amenorrhoea for 6 weeks is suggestive of ectopic pregnancy.

Investigation-

USG of whole abdomen–

to see ectopic pregnancy.
Ultrasound may show dilatation of the ureter if the stone is obstructing urine flow. The stone may also cast an acoustic shadow.

Pregnancy test- positive in ectopic pregnancy.

Treatment-