A 34-year-old man with paraplegia after a snowmobile accident came to the emergency de-partment with a three-day history of fever, ma-laise, and abnormally colored urine. Moderate abdominal pain and anorexia had developed one day before his visit. The patient did not have headache, neck stiffness, photophobia, shortness of breath, nausea, vomiting, diarrhea, jaundice, or weight loss. I need to know more about the character of the abdominal pain. This patient's paraplegia might in-fluence the development and localization of his ab-dominal pain. The fever, malaise, and abnormal urine color immediately raise the possibility of a uri-nary tract infection. Patients with pyelonephritis may present not only with abdominal pain but also with an acute abdomen, so his symptoms, including the abdominal pain, could be explained by a urinary tract infection. I would like to know whether he has any flank pain or has had previous urinary tract infec-tions, and how long he has had paraplegia.
Bohan, J. S. (2016, May 1). Clinical Problem Solving: Back to the Basics. Annals of Emergency Medicine. Mosby Inc. https://doi.org/10.1016/j.annemergmed.2016.01.019