26th August 2024

A 25-year-old woman presents to hospital with abdominal pain which has come on over the last 8 hours

A 25-year-old woman presents to hospital with abdominal pain which has come on over the last 8 hours. This is severe in nature and is associated with vomiting. She has a past medical history of asthma and anxiety. You note that she has presented multiple times to A&E with severe abdominal pain with no cause found for her symptoms and had a laparotomy last year for possible appendicitis, which turned out to be negative. Her current medications are salbutamol, Clenil and citalopram. She has been taking paracetamol and codeine for the pain and some tramadol that her mother had for back pain.

Her abdominal pain is constant, 10/10 severity, and she is unable to point to one region of her abdomen which is most severe. On examination, her abdomen is distended and her pain is diffuse, but you can identify no particularly tender regions, there is no rebound tenderness. Her bowel sounds are diminished. She also notes pains and numbness sensations in her arms and legs for the past few days, and you note that she seems to be having difficulty raising her arms off the bed. She is agitated, restless and sweaty. Her observations show a heart rate of 125 bpm, RR 22, sats 100%, BP 179/107, and temperature of 36.7 degrees.

Blood results are as follows:

Hb 140 [140 – 180]

WCC 8.67 [4.0 – 10.0]

Plts 333 [150 – 400]

CRP 4 [<5]

Na 130 [135 – 145]

ALT 120 [10 – 40]

ALP 120 [35 – 104]

Bilirubin 13 [5 -21]

An ECG shows sinus tachycardia. A urine pregnancy test is negative. The nurse looking after her was concerned that the urine sample looked like it had blood in it so performed a urine dip, but this turned out to be negative. CT AP performed in A&E has shown no pathology so she has been referred to the medical team for admission.  Given the likely diagnosis, what treatment should be offered?

Select the SINGLE most appropriate option from the list below. Select ONE option only.