If the US is non-diagnostic, further imaging with CT or MRI, particularly in pregnancy, is required. The visualization of a thickened, non-compressible appendix greater than 6 mm in diameter is diagnostic. The advantages include decreased cost relative to other imaging modalities and lack of ionizing radiation exposure. Use of ultrasound is increasing, particularly in children in whom the risks of ionizing radiation are greatest. Consultation should not be delayed for testing. Consider obtaining a surgical consultation before imaging, particularly in patients with the typical presentation. Imaging is particularly helpful in doubtful cases such as in female patients of child-bearing age. Imaging may not be universally required and may be unnecessary when the diagnosis is clear. Urinalysis is usually normal but may not be due to the inflamed appendix sitting on the ureter or bladder.Īppendicitis is a clinical diagnosis. A normal WBC is also not uncommon in patients with appendicitis. Many patients with gastroenteritis, mesenteric adenitis, pelvic inflammatory disease, and many other conditions have an elevated WBC. Īlthough an increase in peripheral WBC with a left shift may be the earliest marker of inflammation, its presence or absence is not significant enough to diagnose or exclude acute appendicitis. Although lab results may help to support the clinical diagnosis, it cannot replace a good history and physical examination. Practitioners should interpret laboratory evaluations in association with the patient's clinical history and physical examination findings. Not a single feature of the history or physical finding can reliably diagnose or exclude the diagnosis of appendicitis. Note that rectal examination does not provide any additional information in the evaluation of appendicitis. Obturator sign is increased RLQ pain when the patient is supine, and the provider internally and externally rotates the right leg as it is flexed at the hip.īeware that the presence or absence of any of these findings is not sufficient enough to prove or disprove the diagnosis. Psoas sign is increased RLQ pain with the patient lying on their left side while the provider passively extends the patient's right leg at the hip with both knees extended. Rovsing's sign is right lower quadrant (RLQ) pain while palpating the left lower quadrant. Rebound tenderness and involuntary guarding may suggest peritonitis. Tenderness in this area is perhaps the most useful clinical finding. Tenderness in the right lower quadrant at McBurney’s point (two-third the distance from the umbilicus to the right anterior superior iliac spine). Long appendix can present as a right upper quadrant or left lower quadrant pain.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |