Your
patient explains that her pain began about 3 weeks prior to her
presentation and has gradually worsened.
The pain is sharp in nature and located in the middle of her upper
abdomen, just below her rib cage. It
occurs most often between meals and is relieved with meals only to recur
several hours later. She
denies any weight loss, anorexia, dysphagia, diarrhea or constipation.
Her stools are a bit darker than usual but without any signs of
bright red blood. She has
never had pain like this in the past, is uncertain as to its cause, and
has been using some over the counter antacid without relief.
Her
last menstrual period was 3 weeks prior to her presentation and was of the
usual timing (q 28 days) and duration (5 days). Her abdominal pain did not worsen during the time of her
menses. She does not consider
her periods heavy. She uses
condoms and spermicidal lubricant for birth control.
She is sexually active with her boyfriend of the last 6 months,
with whom she feels safe and supported; she has no history of domestic
violence. She has never
contracted a sexually transmitted disease.
She
has smoked one pack of cigarettes a day for 25 years, rarely drinks
alcoholic beverages, and uses no other substances.
She uses no aspirin or nonsteroidal products.
She
works as a legal secretary for a large law firm. Her oldest child, a son, is away at college; her two youngest
children are at home including a 12 year old daughter recently diagnosed
with a learning disability. She
had all of her children by her former husband from whom she’s been
divorced for three years. She
reports some stress related to being a single parent and sharing custody
but does not believe that this is the cause of her abdominal pain.
