Hello, med students. My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast.

Last week, we learned that a good abdominal pain differential, the type of differential that earned kind of that top one-third on your slow,

it's not limited to quadrants.

Don't limit your differential diagnosis of abdominal pain to things that are found

classically in a quadrant.

Many life-threatening intra-abdominal causes of abdominal pain don't match a quadrant.

And that's even if you exclude all of your non-GI causes of abdominal pain as well.

If your differentials are only including classic quadrant-based diagnoses, you're behind.

That's only a quarter probably of what you need to actually know for your clerkship.

So when we had talked about this last week, we basically

covered the first two intra-abdominal causes of abdominal pain that aren't located in a quadrant,

mezzanteric ischemia, in small bowel obstruction. And this week, we're going to be wrapping up

with two more bowelies. So here's our case.

Hello, Dr. Olson. I have an 80-year-old female with a history of hysterectomy,

peptic ulcer disease, chronic constipation, diverticulosis, and she presents with abdominal pain.

She comes from a nursing home and has advanced dementia.

So history is limited.

But she seems to be having severe, sudden abdominal pain.

The skilled nursing facility says that she didn't eat dinner last night and was just kind of out of it this morning.

So they sent her here for evaluation.

They state that she has been constipated

and that she's also been having some dark stools. But according to the report, there's been no

...