HPI: A 25 year old African American female with past medical history significant for HIV presents with 9 hours of generalized abdominal pain accompanied by 5 episodes of nonbloody/nonbilious vomiting and 2 episodes of diarrhea. She experienced a similar illness one week earlier, but it was relieved by Tylenol within 24 hours. She denies any association with meals and was able to eat a large lunch the previous day. She also denies any fever, burning or frequency with urination, or vaginal bleeding. No sick contacts or recent travel. Her LMP was 9/15/06 and she normally has very regular menstruation.

Past Medical Hx: G4P4. TSVD in 2005. HIV+, diagnosed 2004. CD4 count currently unknown.

Past Surgical Hx: Bilateral Tubal Ligation 2005

Meds: None

Social Hx: Smokes 2 packs per day. Denies alcohol and drug use.

Thanks to Mike Wade, MD, and Doug Gregorie, MSIV, in the development of this web case

Physical Exam
Vitals: Temp 98.2, pulse 86, respirations 18, BP 157/95
General: AAOx3. Mild to moderate distress
HEENT: Pupils are reactive to light. EOMI
Neck: Supple without rigidity. No lymphadenopathy
Respiratory: CTAB
Abdomen: Nondistended. Generalized tenderness with more intense pain in the left and right lower quadrants. Generalized voluntary guarding without rigidity. Decreased bowel sounds. No masses, bruits or hernias.
Extremities: No clubbing, cyanosis, or edema. Peripheral pulses 2+ and equal.
Genitourinary: Mild cervical motion tenderness. Vagina clear of discharge, no adnexal tenderness present. No leisions seen.

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