Appendicitis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍abdominalRLQ pain

Symptoms include:

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍migrating abdominal pain to lower right side

‍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



Contributing factors:

‍low-fiber diet

no history of: ‍abdominal surgeries





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Appendicitis ‍likelysuspectedpossible

DDx: acute appendicitis, perforated appendicitis, appendiceal abscess, chronic appendicitis, mesenteric adenitis, gastroenteritis, diverticulitis, ectopic pregnancy, ovarian cyst rupture, ovarian torsion, endometriosis, fibroids, urinary tract infection, renal colic, kidney stones, cholecystitis, pancreatitis, peptic ulcer disease, inflammatory bowel disease, irritable bowel syndrome, functional abdominal pain, small bowel obstruction, colorectal cancer, intestinal ischemia, abdominal wall pain, constipation, pelvic inflammatory disease





PLAN:

Investigations:

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

- CT scan of abdomen

- Abdominal ultrasound

Treatments:

- NPO

- IV fluids

- ‍Analgesics

- ‍IV opioids

- ‍Anti-emetics

- ‍Antibiotics

Further care:

- Referral to general surgeon

- Follow-up in ‍ ‍daysweeks

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

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