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Appendicitis Pps
Appendicitis Pps
Negative Family HX
What is your Differential Diagnosis?
Differential Diagnosis
Based on History and Presentation
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
Physical Examination
VAGINAL: nontender, no
HEENT : No icterus Discharge
CV : nl S1S2, no murmurs RECTAL: Guaiac neg,
uncomfortable during exam
PULM : CTA Bilat. no pain with Neuromuscular: Minimal
inspiration hyperesthesia above umbilicus
ABD : Moderately tender in RLQ
between pubic symphysis and
ASIS, involuntary guarding, Neg
bowel sounds
Would you like to revise your
Differential Diagnosis?
Would you like to revise your
Differential Diagnosis?
Acute appendicits
Diverticulitis (Meckels)
Inflammatory Bowel Disease (Crohns)
Ovarian pathology
Acute cholecystitis
Intestinal obstruction
Nonspecific adenitis Possible Yersinia infection
Laboratory
CBC Electrolytes
B-HCG Urinalysis
Lab Results, Ms. Cope
CBC: 14,500
LFTs : WNL
HCG : WNL
Electrolytes : WNL
Amylase : WNL
U/A: WNL
Interventions at this point?
Interventions at this point?
Consider the following
Flat/Upright Abdomen
CT Scan: Abd/Pelvis
CT Scan: Other ?
US Abdomen/Pelvis
Considering your Differential Diagnosis
Additional Imaging?
Observation?
OR?
Other?
What next?
Surgical Options
Pre-operative preparation
Laparoscopic Acute Appendicitis
Discussion