Presentation Blunt injuries to the scrotum usually occur in patients who are younger than 50 years of age as a result of an athletic injury; a straddle injury; an automobile, motorcycle, or industrial accident; or an assault. Patients present with various degrees of pain, ecchymoses, and swelling as well as faintness, nausea, or vomiting ( Fig. 77.1 ). The symptoms from minor injuries will gradually resolve…

Presentation The patient typically seeks medical care 1 to 6 hours after eating because of severe nausea, vomiting, retching, and abdominal cramps that may progress later into diarrhea. Patients may present with a wide range of findings. Signs and symptoms can range from mild to severe illness. It begins with minor nausea, vomiting, malaise, and diarrhea, progressing to conditions where patients may appear very ill: pale,…

Presentation Recurring, unpredictable, clonic contractions of the diaphragm that produce sharp inhalations are known as singultus or more commonly as hiccups. Hiccups are usually precipitated by some combination of laughing, talking, eating, and drinking but may also occur spontaneously. Most cases resolve spontaneously, and patients do not come to a physician’s office unless hiccups are prolonged or severe. A bout of hiccups is any episode lasting…

Presentation Patients with external hemorrhoids ( Fig. 74.1 ) generally complain of a painful anal lump of sudden onset, which may become intense in severity. This type of pain, in most instances, represents a thrombosed hemorrhoid, which will appear to be purple and is located within the anal canal. It may have been precipitated by straining during defecation, heavy lifting, or pregnancy, but in most cases,…

Presentation Parents bring in a young child (usually between the ages of 6 months and 6 years) shortly after the child has swallowed a coin, safety pin, or toy. The child may be asymptomatic or have recurrent or transient symptoms of choking, gagging, vomiting, drooling, dysphagia, pain, or a foreign-body (FB) sensation. Stridor or dyspnea resulting from tracheal compression may occur in young children. Disturbed or…

Presentation Rectal foreign bodies may present with abdominal pain, anorectal pain, obstipation, acute urinary retention, or blood or mucous discharge from the rectum. Such foreign bodies are often difficult to diagnose because the history may not be offered by the patient unless directly asked. Sometimes the patient will not volunteer that any object has been inserted or will give outlandish explanations, such as having sat or…

Presentation The patient develops symptoms either immediately after swallowing a large mouthful of food (usually inadequately chewed meat) or as the result of intoxication, wearing dentures, or being too embarrassed to spit out a large piece of gristle. The patient often develops substernal chest pain that may mimic the pain of a myocardial infarction. This discomfort increases with swallowing and is followed by retention of salivary…

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Presentation Complaints may range from occasional stool that is not well formed to acute, copious diarrhea that produces profound dehydration and shock. Patients with inflammatory or infectious diarrhea often present with fever, tenesmus (the frequent urge to defecate), abdominal pain, and hemoccult-positive stool. These conditions usually cause a more severe form of diarrhea and require more careful assessment and more aggressive treatment. Noninflammatory diarrhea is usually…

Presentation Patients with functional constipation will often come in with the complaint of abdominal pain or bloating. Often it is not until they are asked that they will describe infrequent bowel movements, straining at stooling, incomplete evacuation, hard or small stools, a blockage in the anal region, or the need for digital manipulation to enable defecation. Patients with irritable bowel syndrome (IBS) will complain of abdominal…

Presentation The patient presents complaining of a gastrostomy tube (G-tube) or jejunostomy tube (J-tube) that is not functioning properly. The most common complaints are that the tube is obstructed, leaking, displaced, or that there is pain and/or redness surrounding the stoma. Depending on how long the complication has persisted and how dependent on the tube the patient is, the presentation can range from otherwise well-appearing patients…

Presentation In most patients, the symptoms are so characteristic that they are nearly diagnostic. Initial onset of pain often occurs during or after defecation, usually after passing a large, hard bowel movement or following an explosive bout of diarrhea. Later, patients complain of severe intense pain with subsequent defecation. It can be described as knifelike, cutting, or tearing in character. This pain can persist for a…

Presentation A patient with an isolated rib fracture or a minor costochondral separation usually has recently fallen, injuring the side of the chest; been struck by a blunt object; coughed violently; or leaned over a rigid edge. The initial chest pain may subside, but over the next few hours or days the pain increases with movement, interferes with sleep and activity, and becomes severe when the…

Presentation The patient may have been sprayed with tear gas (e.g., Mace) during a riot being dispersed by the police or may have accidentally sprayed oneself. The patient might complain of burning of the eyes, nose, mouth, and skin, as well as tearing and inability to open the eyes because of the severe stinging. There may be sneezing, coughing, runny nose, and perhaps a metallic taste…

Presentation The patient was trapped in an enclosed space with toxic gases or fumes (e.g., produced by a fire, a leak, evaporation of a solvent, a chemical reaction, or fermentation of silage) and comes to the emergency department or acute care center complaining of coughing, wheezing, shortness of breath, irritated or runny eyes or nose, or skin irritation. More severe symptoms include confusion and narcosis, dizziness,…

Presentation Patients, typically younger than age 40, present with a day or more of steady aching with intermittent stabbing chest pain. The pain may follow an episode of minor trauma, a period of frequent coughing, or unusual physical activity or overuse. The symptoms may be localized to the left or right of the sternum and may worsen when the patient takes a deep breath, changes position,…

Presentation The patient’s symptoms generally begin with 1 to 5 days of fever, malaise, and myalgias that are often indistinguishable from other acute upper respiratory tract infections (URIs). With acute bronchitis, the acute phase is followed by a second phase characterized by persistent cough, often accompanied by phlegm production or wheezing. This second phase usually lasts 1 to 3 weeks but may last as long as…

Presentation The patient presents with a foreign-body sensation or a fullness or lump in the throat, possibly associated with a slightly muffled voice and gagging. Often patients have seen their swollen uvula after looking in a mirror. On examination of the throat, the uvula is boggy, swollen, pale, and somewhat translucent and gelatinous appearing (uvular hydrops). If greatly enlarged, the uvula might rest on the tongue…

Presentation Patients present with the inability to close the jaw, usually after yawning, laughing, taking a large bite of food, suffering a traumatic jaw injury, or having a dystonic drug reaction. Such patients have difficulty enunciating clearly. Although they usually have only mild to moderate discomfort, they may have severe pain anterior to the ear. A depression can be seen or felt in the preauricular area,…

Presentation Patients usually complain of poorly localized facial pain or headache that does not appear to conform to a strict anatomic distribution. The pain is generally dull and unilateral, centered in the temple above and behind the eye, and in and around the ear. The pain may be associated with mastication and passive movement of the mandible, instability of the temporomandibular joint (TMJ), crepitus, or clicking…