Date of birth and address confirmed. Consented to view his medical notes.

Presenting Complaint

Right sided abdominal pain

History of Presenting Complaint

Patient has a background history of irritable bowel syndrome and is accustomed to stomach cramps preceding bowel movements
Two days ago experienced stomach cramps that were different from his usual irritable bowel syndrome related cramps, which subsequently resolved
The following day developed a stomach ache which has progressively worsened over the past 24 hours
Initially the pain was generalised across the abdomen but has now localised to the right side
Felt very bloated and distended with abdominal tightness, particularly overnight
Pain was severe overnight and affected his ability to sleep, with all movement being painful
Managed to get some sleep in the early morning hours
Right side of abdomen is very tender and sore on palpation
No fever reported
Felt nauseous last night and vomited a small amount of liquid, which was partially self induced
No diarrhoea or constipation reported
No blood in stools
Standing upright is painful and bending over slightly provides some relief
Has not been able to leave the house today due to pain
Feeling weak

Observations

Not discussed

On Examination

Not discussed

Plan

Referred to accident and emergency for urgent assessment due to migratory abdominal pain and concern for possible appendicitis
Blood tests to be performed at hospital
Clinical notes to be sent to the receiving hospital

Safety Netting

Advised to call back if pain worsens or new symptoms develop
Advised to call 999 if unable to get to hospital independently

Transcript[00:00] S1: Hi. Hi. Good afternoon. I started out calling from the NHS one on one service. Is that Mr. Anthony Penn? Yes. Hi, Mr. Penn. Would you mind confirming is your date of birth? The 7th of April 71. Right. And the postcode is N29. JH. HGH. HGH. Yes. Okay. And do I have your permission to view your medical notes?
[00:28] S2: Yes of course.
[00:29] S1: Okay. So I've got here on my brief saying that you are experiencing light right sided stomach pain.
[00:36] S2: Yes.
[00:37] S1: Okay. Tell me exactly what happened.
[00:40] S2: Um, well, I got IBS. Anyway, so I'm used to having stomach cramps preceding, you know, going to the toilet. Um, and that goes away. That's fine. Uh, two days ago on Thursday, I had to stomach cramps, but they weren't the normal kind of IBS ones. But they went away, um, the following day, yesterday, exactly one hour ago. By getting started. This was unusual and I've had that stomach ache since. And it's got worse and worse. So initially I just felt a little bit sore and kind of ill. But last night I was in quite a bit of pain. I felt very bloated and distended. Everything was very tight. So on, um, I was able to sleep on any and everything was very painful. Movement wise. Um, I went out a couple of days and got to sleep in the morning, but the pain had gone from where it felt all around my stomach. It's just to the right hand side.
[01:41] S1: It's a migrating pain.
[01:44] S2: Yeah. It was. It originally felt everywhere, but I think what it was was if I pressed my left side. That's moving. My. Sorry. If I press the right side, that's actually moving my left side of my body a bit. And that was it. So now the right side doesn't hurt at all. It's just the left side. It's very, very tender and sore. Feels like.
[02:00] S1: Have you had any fever?
[02:03] S2: No, no, I had a little bit of I felt sick last night and I did vomit a tiny bit of Liquids. And so that was that was the only kind of thing. So I feel a bit weak at the time. Obviously the pain otherwise.
[02:21] S1: Have you had any vomiting episodes?
[02:27] S2: No, just a little bit last night. But that was kind of I induced that part because I could feel it was there and it wasn't coming out, but I had a little bit of liquid, so.
[02:35] S1: Sure.
[02:35] S2: Have you?
[02:36] S1: No. No, no. Diarrhea or constipation or any either one on one.
[02:40] S2: No, no, I've not been to the toilet since.
[02:42] S1: Any blood in the stool stools.
[02:46] S2: Okay.
[02:46] S1: No. Um, have you been able to leave the house today? Have you gone out when you're walking? Is it painful?
[02:55] S2: Uh, stand up straight is painful. Yeah. Bending over slightly helps. I've not been out when it's just, you know, I'm just too, too short to do anything, so I'm not going anywhere. Sure. Um. Anything?
[03:06] S1: Right. So it sounds to me, Mr. Penn. It sounds to me, once you have this kind of pain, when it's moving one side to another side, this is something you need to go to hospital for. You need to be seen in accidents, in emergency. Um, I know it's not within the age group, but generally with pain that moves. We need to make sure that it's not something more serious, like appendix or anything else.
[03:31] S2: That's what I thought was.
[03:32] S1: Yeah. So, so so this is one of the characteristic type of pain with appendicitis where you get sort of a general pain and then it moves. And therefore therefore the main thing is you need to go in, get your blood test and then discuss from there. Yeah. Yeah.
[03:53] S2: Okay.
[03:53] S1: Okay.
[03:55] S2: Yeah. I wouldn't say the pain has moved so much as localised.
[03:58] S1: Yeah. Localised. But basically there's a change in the place where the pain is or where the pain was. And that essentially is not something that I, you know, you should stay sit on basically.
[04:11] S2: But I think it's just.
[04:13] S1: No no no no I think definitely needs to be seen. Yeah.
[04:18] S2: Yeah, yeah.
[04:19] S1: Okay.
[04:21] S2: Okay. So which service should I use? Then do I. Should I just call because I'm upset? I'm literally on a side of the road to me. Um, but I don't think I actually, I don't know. Uh.
[04:35] S1: Yeah. So whichever is the nearest one, whichever. Do you think is is more suitable for you? Obviously, if you can't get to any, then you can call 999. Um, but otherwise, um. Yeah. The nearest hospital to you, is it? Central Middlesex and north Middlesex.
[04:55] S2: Um, no mosquito is the case.
[04:58] S1: Might not have any. Any.
[05:01] S2: Yeah. So next one would be north I think.
[05:03] S1: North mid. I think north mid would be the best one I can. I'll send my notes over to North mid. In the meantime, if you do develop any worsening pain or symptoms and just give us a call.
[05:15] S2: Okay. So just head over to.
[05:17] S1: Yeah. Absolutely. Absolutely. Okay.
[05:20] S2: Okay. Perfect.
[05:21] S1: All right. Take care. Take care. Bye bye.
[05:23] S2: Bye bye.