1. ID : 71 years old female
CC : Abdominal Pain

2. PRESENT ILLNESS 71 years old female Abdominal pain Periumbilical Colic
Without radiation
Not related to the patient’s position
Anorexia
Last defecation: 2 days ago
Gas passage : +

3. PRESENT ILLNESS
Vomiting : Not bloody Non biliary Contained food remnant No abdominal distention No urinary symptoms No history of fever

4. Drug history : Negative Past medical history: History of an umbilical hernia from several years ago Family history: Negative

5. PHYSICAL EXAMINATION Old female, lying on the bed, toxic but not ill
BP: 120/75 PR: T: RR: 16
Conjunctiva was pale, sclera was not ichteric, JVP was not distended
S4 was auscultated in heart examination
lungs were normal in auscultation

6. PHYSICAL EXAMINATION
Abdominal examination : No distention Bulging could be seen in the umbilical area with out erythema Bowel sounds were hypoactive Generalized tenderness, more severe in the umbilical area No guarding TR: Not bloody, No tenderness, Empty ampula

7. LAB DATA
CBC: Hb: 13.9 WBC: 5800 (73% Neutr) Plt: Na: 138 K: 4 BS: 97 Urea: 37.6 Cr: 0.6 Amylase: 66.7 U/A: PH: 6 color: yellow Appearance: Clear WBC: 2-3 RBC: 2-3 EP: 1-2