Right Lower Quadrant Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of right lower quadrant pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍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

‍flatulence

‍dysuria

‍urinary frequency

‍hematuria

‍menstrual irregularities

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍testicular pain or swelling



Contributing factors:

‍recent travel

‍food allergies or intolerances

‍high-fat diet

no history of: ‍appendicitis, ‍inflammatory bowel disease, ‍hernia, ‍ovarian cysts, ‍ectopic pregnancy, ‍kidney stones, ‍urinary tract infections, ‍previous surgeries

no use of: ‍oral contraceptives, ‍anticoagulants





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





ASSESSMENT:

‍Appendicitis ‍likelysuspectedpossible

DDx: appendicitis, gastroenteritis, urinary tract infection, pelvic inflammatory disease, ectopic pregnancy, ovarian cyst, Crohn's disease, diverticulitis, renal stones, pyelonephritis, inguinal hernia, mesenteric lymphadenitis, constipation, irritable bowel syndrome, endometriosis, fibroids, miscarriage, ovarian torsion, testicular torsion, colorectal cancer, intestinal obstruction, ischemic colitis, tubo-ovarian abscess, sigmoid volvulus, intestinal parasites





PLAN:

Investigations:

- 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

Treatments:

- ‍Analgesics

- ‍Antiemetics

- ‍Antibiotics

- ‍Gastrointestinal spasmolytics

Further care:

- 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