Appendicitis

HISTORY:

‍AbdominalRLQ pain for ‍ ‍hoursdays

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍periumbilical pain migrating to RLQ

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍loss of appetite

‍constipation

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal bloating

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash



ASSESSMENT:

‍Appendicitis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍LFTs, ‍ß-hCG

- CT scan of abdomen

- Abdominal ultrasound

- ‍Dietary modificationsNPO

- IV fluids

- ‍Analgesics

- ‍IV opioids

- ‍Anti-emetics

- ‍Antibiotics

- Referral to general surgeon

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as vomiting, or increased pain

- Go to ER if severe abdominal pain, severe vomiting, or fever occurs