Swole With Pain - Page #1

Author: Kana Maeji, DO
Co Author #1: Justin MJ Young
Senior Editor: Rachel Coel, MD, PhD
Editor: George Harris, MD, MS, FAMSSM, FAAFP

Patient Presentation:
A 49-year-old male presents with a 2-week history of worsening intermittent abdominal pain.

The patient states his pain was not associated with physical activity and was not relieved by rest or medications. He denies recent abdominal exercise with heavy weights. His last bowel movement was one day prior to presentation and he was able to pass flatus.

He previously competed as a bodybuilder but has since only participated recreationally. He admits to using exogenous testosterone and growth hormone for the past 7 years. His last use was 2 weeks prior to presentation. He denies melena, easy bruising or bleeding, blunt force trauma, history of abdominal surgery, or muscle weakness. He has no family history of hypercoagulable disorders. He does not smoke and drinks alcohol rarely. Review of systems is otherwise negative. He has a history of hypertension.

Physical Exam:
Vitals: BP 145/114, HR 92, Temp 98.7 F, RR 24, height 5' 7", weight 267 lbs., SpO2 96%
General: Alert, appears uncomfortable, mildly diaphoretic
HEENT: Normocephalic, moist mucus membranes
Cardiac: Regular rate and rhythm, no murmurs
Lungs: Tachypneic, lungs clear
GI: Distended, tenderness to epigastric and umbilical regions, rebound tenderness and guarding present, hypoactive bowel sounds
MSK: Increased muscle bulk. No joint swelling, no deformity
Skin: Warm, diaphoretic, no rashes
Lymph: No lymphadenopathy
Neuro: No focal deficits noted. Had normal muscle tone. Sensation is grossly intact.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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