Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 23 year old female who presents to the clinic with recurrent abdominal pain.
HPI: The patient reports that the pain occurs every few weeks. It starts a couple of days prior to her menstrual cycle and usually resolves within 72 hours. The pain is crampy in nature with varying intensity. She also feels a constant dull, achy pain. The pain is located in the lower quadrants and suprapubic region. Ibuprofen helps to decrease the severity of the pain. She also complains of nausea, fatigue, and diarrhea with each episode. Her LMP was 6 weeks ago. She normally has irregular menstrual cycles with occasional spotting between periods. She is sexually active with her boyfriend. She is not on any form of birth control. She has never had an abnormal pap smear or any history of STIs. She denies fever/chills, vomiting, constipation, or hematochezia.
ROS: noncontributory
PE:
VS- Temp 98.6, HR 72, BP 116/78, RR 14, Height 5’6”, Weight 165, BMI 26.6
General- Alert and oriented. No acute distress.
Cardiac- RRR. Normal S1 and S2. No murmurs.
Lungs- Clear to auscultation.
Abdomen- Bowel sounds present. No tenderness to light/deep palpation in all quadrants. Negative rebound tenderness and guarding.
Genital- Normal appearing external genitalia. Cervix appears smooth without any lesions or masses. Vaginal vault is pink without lesions or masses. Bimanual exam is unremarkable.
Extremities- No edema