APPENDICIITS

OLD FEMALE CAME TO THE EMERGENCY

DEPARTMENT, A MEDICAL STUDENT COMPLAINING OF LOW
ABDOMINAL PAIN.
TASK: HISTORY, PE FINDING, INVESTIGATION, DIAGNOSIS
AND MANAGEMENT
A 24 YEAR

I know you are in pain. You will be given analgesia

shortly.
Analgesia before examination
Differential diagnosis:
Ectopic Pregnancy
Torsion of Ovary
UTI
PID
Renal Stones
GIT Obstruction
History:
Pain questions: LOTRADIO
Associated symptoms:
Nausea, vomiting, bowel habits and urination, appetite,
fever
Past history: any similar episodes before
General health
Medication and allergy
Menstrual History 5 Ps
Do you think you might be pregnant?
Family history: any in the family with similar problem?
PE: GA VS
Rapidly check heart and lung
Abdomen: bowel sounds
Investigation: scars, bruises, pigmentation, distention
and visible peristalsis
Palpation: mass, tenderness, rigidity, organomegaly,
guarding
Specific Test for Appendicitis:
1. Mc Burneys sign Right iliac fossa tenderness
2. Rebound tenderness pain increased by
sudden release of pressure
3. Rovsings sign pain in left lower quadrant,
pain increase in right side
4. Obturator Sign flexion of hip and knee,
internal rotation causes pain
5. Psoas sign flexion of hip and pain in Right
iliac fossa
PR : tenderness
PV: blood in vaginal vault
Investigation: FBE, ESR,CRP, Urine dipstick, BHCG,
no need for ultrasound
Management: nil by mouth
IV fluid
Analgesia Morphine 2mg IV
Refer to surgeon
Most likely your condition is Appendicitis, it is a common
condition.
Do you know what appendix is?

Appendix is a worm shaped pouch, has no particular

use but can cause problems like inflammation.
1 in 7 Australian has this problem. Diagnosis is mostly
done clinically.
Usual symptoms are abdominal pain, nausea, vomiting,
decrease appetite, fever and diarrhea
The treatment is surgery. If left untreated in 30%
perforation occurs and all abdomen will be infected.
Some complications of surgery like infection, bleeding,
clotting problems or injury to another organ are rare.
But we can prevent it by giving antibiotics
Compression stockings: clotting problem and early
mobilization
How many days in hospital?
Until gut function returns to normal
In 2 weeks usually patient returns to normal activities.