text:  VITAL SIGNS  Temp 98.5   heart rate 74   BP 140  90   respiratory rate 18   O2 sat 98 . GENERAL  The patient was alert but in mild discomfort . HEENT  PERRL   EOMI   oropharynx clear   moist buccal mucosa . NECK  No lymphadenopathy   no JVD . LUNGS  Bibasilar crackles . Breath sounds were of good intensity . HEART  Regular rate and rhythm   normal S1   S2   no murmurs   rubs   or gallops . ABDOMEN  Soft   non-distended . Tender to palpation at the left lower quadrant and especially at the epigastrium . There was no splenomegaly or hepatosplenomegaly . Bowel sounds were present . BACK  Point tenderness at the left costovertebral angle . EXTREMITIES  Warm to touch   no clubbing   cyanosis   or edema . NEURO  The patient was alert and oriented x3 . Deep tendon reflexes were equal and adequate in upper and lower extremities . Cerebellar function was intact . Sensation was intact to pain and light touch .