Professional Documents
Culture Documents
Ms. Z. Cope
You are called to see a patient in the Emergency Department, who is a 25 year-old female with a 1 day history of right-lower quadrant abdominal pain.
History
What other points of the history do you want to know?
History, Patient ZC
Pain started in the middle of the night and woke the patient from sleep. Felt nauseated and vomited after pain No significant MED.HX. or SURG HX. Negative Family HX Noted some indigestion yesterday Feels urge to have bowel movement, but has been constipated
Differential Diagnosis
Based on History and Presentation
Differential Diagnosis
(cont.)
Intra-abdominal conditions
Acute Appendicitis Acute Cholecystitis Diverticulitis (Meckels) Inflammatory Bowel Disease (Crohns) Duodenal Ulcer Intestinal Obstruction Carcinoma of the Cecum Nonspecific adenitis Possible Yersinia infection
Differential Diagnosis
(cont.)
Intra-pelvic conditions
Salpingitis Pelvic Inflammatory Disease Ectopic Pregnancy Ruptured Corpus Luteum Cyst Ruptured Follicular Cyst (Mittelschmerz) Ruptured Ovarian Cyst Ovarian Torsion Pyelonephritis Ureteral/Renal stone
HEENT : No icterus
CV : nl S1S2, no murmurs
PULM : CTA Bilat. no pain with
inspiration
ABD : Moderately tender in RLQ between pubic symphysis and ASIS, involuntary guarding, Neg bowel sounds
Laboratory
Labs ordered
CBC Electrolytes
LFTs B-HCG
LFTs : WNL
HCG : WNL
Electrolytes : WNL
Amylase : WNL
U/A: WNL
Studies
What further studies would you want at this time?
Abdominal Film
CT Scan Results
Acute Appendicitis
Thickened dilated appendix Peri-appendiceal fat stranding Scant free fluid
What next?
What next?
Management
Surgical Options Pre-operative preparation
Discussion
Pathophysiology of the disease process, visceral vs.
parietal abdominal pain, laparoscopy vs. open, antibiotic management, appropriate utilization of resources, etc.
Discussion
Additional teaching points
QUESTIONS ??????
Summary
Alternative scenarios
Acute Appendicitis with perforation/ Abscess or tumor IBD Acute Diverticulitis Ovarian Cyst / Torsion/ Perforated Right colon tumor
CT Cecal Tumor
CT Sigmoid Diverticulitis
CT Acute Appendicitis
Acknowledgment
The preceding educational materials were made available through the