Right Lower Quadrant Pain

HISTORY:

RLQ pain for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍crampingburning

Pattern: ‍constantintermittent

Episode duration: ‍ ‍secminhoursdaysweeksmonths

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots

‍melenic stools, ‍withwithout strong foul smell

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍bloating

‍dysuria

‍urinary frequency

‍hematuria

‍menstrual irregularities

‍vaginal discharge, ‍clear, ‍thin

‍fishy smell

‍testicular pain or swelling

Last menstrual period: ‍ ‍daysweeksmonths ago



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, ‍

CVA tenderness: ‍negativepositive on Rpositive on L

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

Genital: ‍normal, testicles ‍normal, penis ‍normal



ASSESSMENT:

‍Appendicitis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍ß-hCG

- Urinalysis, urine culture

- Abdominal X-ray

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- Pelvic ultrasound

- STI screening for chlamydia and gonorrhea

- Colonoscopy

- ‍Dietary modificationsNPO

- ‍Analgesics

- ‍Antiemetics

- ‍Antibiotics

- ‍Gastrointestinal spasmolytics

- Referral to gastroenterologist

- Referral to general surgeon

- Referral to gynecologist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens or if new symptoms develop such as fever, vomiting, or blood in stools