University:
The University Of Western Ontario
Course:
Biology 2290F | Scientific Method in Biology
Academic year:

2022
Views:

359

Pages:

3
Author:

Kyuwon J.

Patient information ● CC ○ 22 year old RLQ abdominal pain for 24 hr ○ Nausea, anorexia, slight fever as symptoms ● HPI ○ Peri-umbilical pain ■ Migrated to lower quadrant ○ Constant sharp pain - with movement worsens ○ No urinary symptoms ● Past medical history ○ Nil significant ○ No past surgery ○ No medication ○ NKDA Physical examination System General Mild distress due to pain Abdomen Tenderness in RLQ, rebound tenderness at McBurney’s point, positive Rovsing sign Vitals Temp 37.9°C, HR 95, BP 122/76, RR 18 Test CBC ↑ WBC (13,000/mm³), neutrophilia CRP Elevated Urinalysis Normal (rules out UTI) Imaging Ultrasound: non-compressible appendix (if equivocal → CT Abdomen: inflamed appendix with fat stranding) Laboratory test Test Result Interpretation CBC ↑ WBC (13,000) with neutrophilia Indicates infection/inflammation CRP Elevated Non-specific marker of inflammation Urinalysis Normal Rules out UTI, helps narrow diagnosis Diagnosis ● With clinical history ○ Periumbilical pain = migrate to RLQ ■ Pattern of appendicitis since visceral somatic nerve transition ○ Anorexia nausea and mild fever ■ Not specific but common for appendicitis ○ Movement worsen pain ■ Peritoneal irritation (inflammation and spreading) History alone may raise suspicion for appendicitis ● McBurney’s point tenderness ○ Localized position of appendix ● Rebound tenderness ○ Peritoneal inflammation ● First line - ultrasound ○ Not compressible ■ Less then 6mm diameter with tubular structure RLQ ■ Used early ■ Limited in habitus Conclusion ● Diagnosis of acute appendicitis through lab and imagin ○ Patient has past history on pain migration ○ RLQ tenderness was seen in examination ■ Rovesing’s sings ○ Leukocytosis + neutrophilia has been seen in laboratory ○ CRP increase ○ CT scan had confirmed inflammation of appendix Multiple evidence is needed for fair conclusion Justifies for immediate surgical interention Inflammation of vermiform appendix ● Through HPI to onset + migration of pain ● Position based signs ● Can use imaging if unclear ○ Even with clear symp, still use imaging for clear adjustment + faster treatment ● Most case, Appendectomy is safe ● Rule out reproductive causes - female