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You are explaining unexplained hypotension
Lab Rats In Lab Coats
You are explaining unexplained hypotension
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Lab Rats In Lab Coats
Appendicitis
Classic presentation
The classic presentation of appendicitis is abdominal pain that is initially diffuse and then intensifies and migrates toward the right lower quadrant (RLQ) to McBurney point (1.5–2 inches from the anterior superior iliac crest toward umbilicus).
It should be mentioned that the textbook presentation of nausea, vomiting, and pain migration is present only in 50–65% of patients, while fever is present in only 40% of patients with perforated appendices.
Also, patients often complain of bloating and anorexia.
The classic presentation of appendicitis is abdominal pain that is initially diffuse and then intensifies and migrates toward the right lower quadrant (RLQ) to McBurney point (1.5–2 inches from the anterior superior iliac crest toward umbilicus).
It should be mentioned that the textbook presentation of nausea, vomiting, and pain migration is present only in 50–65% of patients, while fever is present in only 40% of patients with perforated appendices.
Also, patients often complain of bloating and anorexia.
Investigation
The migration of pain to the RLQ is the most useful clinical finding.
Other clinical findings like guarding and rebound tenderness increase the likelihood of appendicitis.
The WBC count and CRP, although always done, but cannot reliably rule in nor rule out acute appendicitis.
Urinalysis may be misleading and reveal pyuria and hematuria due to bladder inflammation from an adjacent appendicitis.
CT scanning is the best test at ruling out appendicitis when the diagnosis is uncertain (Sensitivity 92%, specificity 97%).
Ultrasound or MRI, although less reliable, but can be used as alternatives in cases of pregnancy or unavailability of CT.
If the patient is a female at child-bearing age, you should do a pregnancy test to rule out ruptured ectopic pregnancy.
There are 2 "rules" that can help in clinical decision:
• The Alvarado score
• The appendicitis inflammatory response (AIR) score
Hamburger sign:
To check for anorexia. Ask the patient if they would like to eat their favourite food, if yes, then they don't have anorexia, therefore it's unlikely to be appendicitis.
The migration of pain to the RLQ is the most useful clinical finding.
Other clinical findings like guarding and rebound tenderness increase the likelihood of appendicitis.
The WBC count and CRP, although always done, but cannot reliably rule in nor rule out acute appendicitis.
Urinalysis may be misleading and reveal pyuria and hematuria due to bladder inflammation from an adjacent appendicitis.
CT scanning is the best test at ruling out appendicitis when the diagnosis is uncertain (Sensitivity 92%, specificity 97%).
Ultrasound or MRI, although less reliable, but can be used as alternatives in cases of pregnancy or unavailability of CT.
If the patient is a female at child-bearing age, you should do a pregnancy test to rule out ruptured ectopic pregnancy.
There are 2 "rules" that can help in clinical decision:
• The Alvarado score
• The appendicitis inflammatory response (AIR) score
Hamburger sign:
To check for anorexia. Ask the patient if they would like to eat their favourite food, if yes, then they don't have anorexia, therefore it's unlikely to be appendicitis.
Treatment
Surgery remains the treatment of choice.
Broad-spectrum antibiotics can be used as alternatives, but they are not very reliable and have a 30% chance of recurrence within 1 year.
Surgery remains the treatment of choice.
Broad-spectrum antibiotics can be used as alternatives, but they are not very reliable and have a 30% chance of recurrence within 1 year.
Absent bowel sounds, guarding, and rebound tenderness (Blumberg sign) all point to peritoneal involvement secondary to appendicitis.