Dorothy Jones i-Human NR 509 Week 8 | Acute
Severe Abdominal Pain 2026 Case Study Edition
,1. PATIENT BIODATA & REASON FOR ENCOUNTER
Category Information
Patient Name Dorothy Jones
Age 54 years
Sex Female
Date of Birth 03/15/1972
Race/Ethnicity Caucasian
Height 5'6" (168 cm)
Weight 165 lbs (75 kg)
BMI 26.6 (Overweight)
Occupation Dental Office Receptionist
Living Situation Lives with daughter
Setting Emergency Department
Date/Time of Encounter 06/29/2026, 14:30
Mode of Arrival Private vehicle (driven by daughter)
Reason for Encounter "My stomach hurts. It started 3 days ago and has gotten worse. I can't keep anything down and
haven't had a bowel movement in 2 days."
2. CASE INTRODUCTION
Dorothy Jones is a 54-year-old Caucasian female who presents to the Emergency Department with a chief complaint of
progressively worsening abdominal pain. The pain began three days ago shortly after dinner and has intensified
significantly, now rated 8-9/10 on the pain scale. She reports associated nausea with bilious (greenish-yellow) vomiting,
obstipation (no bowel movement or flatus for 2 days), and progressive abdominal bloating.
Her past medical history is significant for hyperlipidemia, chronic constipation, and a history of gallstones. Most notably,
she has a history of multiple abdominal surgeries including cholecystectomy (10-15 years ago) and hysterectomy with
fibroid removal (1-2 years ago). These surgical histories place her at significant risk for adhesive small bowel obstruction.
,The periumbilical location, crampy and colicky character of the pain, combined with obstructive symptoms (bilious vomiting
and obstipation), strongly suggest a mechanical bowel obstruction as the primary consideration. Prompt recognition and
management are essential to prevent complications such as bowel ischemia, perforation, or sepsis.
3. CHIEF COMPLAINT
"My stomach hurts. It started 3 days ago and has gotten worse."
4. QUESTIONS AND ANSWERS DURING FULL HISTORY
A. HISTORY OF PRESENT ILLNESS (HPI) QUESTIONS
Clinician Question Patient's Response
"What brings you in today?" "I've had this belly pain for three days, and it's getting worse."
"Where exactly is the pain located?" "Right in the middle of my abdomen, around my belly button."
"When did the pain first start?" "It started three days ago, just after dinner. I thought it was something I ate, but it
kept getting worse."
"How would you describe the pain?" "It's crampy—like someone is squeezing my stomach from the inside. It comes in
waves."
"On a scale of 0-10, how severe is the pain?" "When the waves come, it's an 8 or 9. Between waves, maybe a 4."
"Does the pain radiate anywhere?" "No, it just stays in the middle."
"What makes the pain better?" "I feel a little better right after I throw up, but it doesn't last long."
"What makes the pain worse?" "Eating or drinking. And when I press on my belly."
"Have you been vomiting?" "Yes. The first time it was food I just ate. Now it's greenish-yellow liquid."
"When was your last bowel movement?" "Two days ago. And I haven't passed gas either, which isn't normal for me."
"Do you have any bloating?" "Yes, my stomach is bigger than normal. I feel really bloated and full."
"Have you had fever or chills?" "I feel warm, but I haven't checked my temperature. No chills."
"Any changes in urine color?" "It's dark orange right now."
"Any changes in stool color?" "They are pale colored."
"Have you had this pain before?" "I've had gallbladder pain before, but never like this or for this long."
"What treatments have you tried at home?" "Nothing. I just thought it would go away."
"Are you able to keep any food or fluids down?" "No, I throw everything up. I'm not even hungry."
, B. REVIEW OF SYSTEMS (ROS) QUESTIONS
System Clinician Question Patient Response
General "Have you had any fever, chills, or night sweats?" "I feel warm but haven't taken my temperature. No
chills."
General "Any recent unintentional weight loss?" "No, not that I've noticed."
General "How is your energy level?" "I feel exhausted and weak."
HEENT "Any headaches or vision changes?" "No."
HEENT "Any sore throat or neck stiffness?" "No."
CV "Any chest pain or palpitations?" "No."
Resp "Any shortness of breath or cough?" "No, breathing is fine."
GI "Describe your nausea." "It's constant and gets worse with the pain waves."
GI "What color is the vomit?" "Greenish-yellow now. At first it was just food."
GI "Any blood in your vomit?" "No."
GI "Any blood in your stool?" "No."
GI "Any diarrhea?" "No, I haven't had a bowel movement at all."
GI "Any rectal pain or bleeding?" "No."
GU "Any burning with urination?" "No."
GU "Any frequency or urgency?" "No, but I'm not going as much."
MSK "Any joint or muscle aches?" "No."
Neuro "Any dizziness or fainting?" "A little lightheaded when I stand up."
Psych "Are you feeling anxious?" "Yes, I'm really worried about what's wrong."
Integ "Any rash or skin changes?" "No."
C. PAST MEDICAL HISTORY QUESTIONS
Clinician Question Patient Response
"What medical conditions do you have?" "I have high cholesterol and I get constipated sometimes. I used to have
gallstones."
"When were you diagnosed with these conditions?" "High cholesterol was about 5 years ago. Constipation has been a
problem for years."
Severe Abdominal Pain 2026 Case Study Edition
,1. PATIENT BIODATA & REASON FOR ENCOUNTER
Category Information
Patient Name Dorothy Jones
Age 54 years
Sex Female
Date of Birth 03/15/1972
Race/Ethnicity Caucasian
Height 5'6" (168 cm)
Weight 165 lbs (75 kg)
BMI 26.6 (Overweight)
Occupation Dental Office Receptionist
Living Situation Lives with daughter
Setting Emergency Department
Date/Time of Encounter 06/29/2026, 14:30
Mode of Arrival Private vehicle (driven by daughter)
Reason for Encounter "My stomach hurts. It started 3 days ago and has gotten worse. I can't keep anything down and
haven't had a bowel movement in 2 days."
2. CASE INTRODUCTION
Dorothy Jones is a 54-year-old Caucasian female who presents to the Emergency Department with a chief complaint of
progressively worsening abdominal pain. The pain began three days ago shortly after dinner and has intensified
significantly, now rated 8-9/10 on the pain scale. She reports associated nausea with bilious (greenish-yellow) vomiting,
obstipation (no bowel movement or flatus for 2 days), and progressive abdominal bloating.
Her past medical history is significant for hyperlipidemia, chronic constipation, and a history of gallstones. Most notably,
she has a history of multiple abdominal surgeries including cholecystectomy (10-15 years ago) and hysterectomy with
fibroid removal (1-2 years ago). These surgical histories place her at significant risk for adhesive small bowel obstruction.
,The periumbilical location, crampy and colicky character of the pain, combined with obstructive symptoms (bilious vomiting
and obstipation), strongly suggest a mechanical bowel obstruction as the primary consideration. Prompt recognition and
management are essential to prevent complications such as bowel ischemia, perforation, or sepsis.
3. CHIEF COMPLAINT
"My stomach hurts. It started 3 days ago and has gotten worse."
4. QUESTIONS AND ANSWERS DURING FULL HISTORY
A. HISTORY OF PRESENT ILLNESS (HPI) QUESTIONS
Clinician Question Patient's Response
"What brings you in today?" "I've had this belly pain for three days, and it's getting worse."
"Where exactly is the pain located?" "Right in the middle of my abdomen, around my belly button."
"When did the pain first start?" "It started three days ago, just after dinner. I thought it was something I ate, but it
kept getting worse."
"How would you describe the pain?" "It's crampy—like someone is squeezing my stomach from the inside. It comes in
waves."
"On a scale of 0-10, how severe is the pain?" "When the waves come, it's an 8 or 9. Between waves, maybe a 4."
"Does the pain radiate anywhere?" "No, it just stays in the middle."
"What makes the pain better?" "I feel a little better right after I throw up, but it doesn't last long."
"What makes the pain worse?" "Eating or drinking. And when I press on my belly."
"Have you been vomiting?" "Yes. The first time it was food I just ate. Now it's greenish-yellow liquid."
"When was your last bowel movement?" "Two days ago. And I haven't passed gas either, which isn't normal for me."
"Do you have any bloating?" "Yes, my stomach is bigger than normal. I feel really bloated and full."
"Have you had fever or chills?" "I feel warm, but I haven't checked my temperature. No chills."
"Any changes in urine color?" "It's dark orange right now."
"Any changes in stool color?" "They are pale colored."
"Have you had this pain before?" "I've had gallbladder pain before, but never like this or for this long."
"What treatments have you tried at home?" "Nothing. I just thought it would go away."
"Are you able to keep any food or fluids down?" "No, I throw everything up. I'm not even hungry."
, B. REVIEW OF SYSTEMS (ROS) QUESTIONS
System Clinician Question Patient Response
General "Have you had any fever, chills, or night sweats?" "I feel warm but haven't taken my temperature. No
chills."
General "Any recent unintentional weight loss?" "No, not that I've noticed."
General "How is your energy level?" "I feel exhausted and weak."
HEENT "Any headaches or vision changes?" "No."
HEENT "Any sore throat or neck stiffness?" "No."
CV "Any chest pain or palpitations?" "No."
Resp "Any shortness of breath or cough?" "No, breathing is fine."
GI "Describe your nausea." "It's constant and gets worse with the pain waves."
GI "What color is the vomit?" "Greenish-yellow now. At first it was just food."
GI "Any blood in your vomit?" "No."
GI "Any blood in your stool?" "No."
GI "Any diarrhea?" "No, I haven't had a bowel movement at all."
GI "Any rectal pain or bleeding?" "No."
GU "Any burning with urination?" "No."
GU "Any frequency or urgency?" "No, but I'm not going as much."
MSK "Any joint or muscle aches?" "No."
Neuro "Any dizziness or fainting?" "A little lightheaded when I stand up."
Psych "Are you feeling anxious?" "Yes, I'm really worried about what's wrong."
Integ "Any rash or skin changes?" "No."
C. PAST MEDICAL HISTORY QUESTIONS
Clinician Question Patient Response
"What medical conditions do you have?" "I have high cholesterol and I get constipated sometimes. I used to have
gallstones."
"When were you diagnosed with these conditions?" "High cholesterol was about 5 years ago. Constipation has been a
problem for years."
