Left-sided Abdominal Pain in a 45-yr-old Man

Physical Examination

  • General appearance: Appears nontoxic but seems uncomfortable on the exam bed.

  • Vital signs:
  • Temperature: 37° C
  • Pulse: 99 beats/min
  • BP: 150/90 mm Hg
  • Respirations: 16/min
  • Height: 6 ft (1.83 m)
  • Weight: 300 lb (136 kg)
  • BMI: 40.7

  • Skin: Warm and dry to the touch. No rash or lesions.

  • HEENT: Unremarkable

  • Pulmonary: Breath sounds present and equal bilaterally. No stridor, rales, or wheezing.

  • Cardiovascular: Regular rate and rhythm; no murmurs or rubs. Radial and pedal pulses present and equal bilaterally. No pedal edema.

  • Gastrointestinal: No ecchymoses. Bowel sounds normal in all quadrants. Abdomen nondistended, soft, and nontender to light and deep palpation; no guarding, rigidity, rebound, or masses. Negative Murphy sign. Rectal exam is heme-negative.

  • Genitourinary: Circumcised penis, bilateral descended testes. Testes and epididymal bodies nontender to palpation. No costovertebral angle tenderness.

  • Musculoskeletal: Muscle strength is intact in all four limbs without any tenderness to palpation or movement.

  • Neurologic: Unremarkable

  • Mental status: Alert and oriented to person, place, time, and event.