Fast Track to Abdominal Pain

An NP student you are precepting in the emergency department fast track area presents her patient to you: a 60-year-old woman with abdominal pain. The pain is chronic but has worsened slightly, prompting the patient, who does not have a primary care provider, to present today. She experiences occasional nausea but no fever, and she denies any bowel or bladder complaints other than constipation. Her medical history is significant for mild hypertension.

On exam, your student notes an obese female who is in no obvious distress. The patient’s vital signs are all within normal limits. The abdominal exam is unimpressive, revealing a soft abdomen with good bowel sounds. Although she does have mild diffuse tenderness, she has no rebound or guarding.

Although your student suspects the patient is just constipated, she orders blood work and urinalysis. An abdominal survey is obtained as well. What is your impression?