Ms. Z, 39 years old, has been

Ms. Z, 39 years old, has been admitted to the hospital with severe abdominal pain, she has the history of COPD, HTN, and smoking. Earlier that day, she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly improved and the pain seemed to subside somewhat. Later that night, severe, steady abdominal pain developed, with vomiting. A friend took her to the hospital, where examination demonstrated lower right quadrant tenderness and mild abdominal rigidity. Fever and leukocytosis indicated infection. A diagnosis of acute appendicitis, the possible perforation, was indicated, with immediate surgery in the morning. She NPO at midnight.

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