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 ED due to the acute onset of abdominal pain.
HPI: The patient reports that the pain started a few hours ago. It began intermittently and now it has become a more constant ache. The intensity of the pain is progressively worsening. It is located in the suprapubic region. Voiding alleviates the pain for a short time. She also complains of dysuria, increased frequency, urgency, and hematuria. She denies fever/chills, nausea/vomiting, diarrhea/constipation, hematochezia, or vaginal discharge. Her LMP was 6 weeks ago. She normally has irregular menstrual cycles. 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 has not had any sick contacts nor has she eaten anything unusual in the past few days. She has never had pain like this before.
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. Tenderness to light palpation in suprapubic region. Negative McBurneys. Negative rebound tenderness and guarding. No CVA tenderness.
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
Labs:
U/A- +RBCs, >10 leukocytes/microL
Urine dipstick- +leukocyte esterase, + nitrites