Description
A 27 year old caucasian female sales assistant manager was out for a social drink one night. On her way home she fell and hurt her head but did not seek medical attention that evening. The next day she was admitted to the hospital casualty department with severe abdominal pain radiating to the right shoulder. She had cuts and bruises to her face and upper arms but denied being involved in a fight. She was pyrexial with a temperature of 38.5 and had nausea and vomiting with frequency and dysuria. She was not on any medication and a urine pregnancy test was negative. On examination she had a tender, rigid lower abdomen with guarding and re-bound tenderness. The patient was catheterised and given diamorphine. Urinalysis revealed protein (3 ) and macroscopic haematuria. The serum biochemistry test results on admission were:
