DrVirgo
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A 17 year old man comes to the physician because of a ONE-WEEK history of fever and abdominal pain. This began whti mid-abdominal pain and nausea one week ago but he was able to continue his usual activities. However, during the past two days, the pain has become worse. It is now localized to the right iliac fossa and impairs walking. He has had two episodes of vomiting during the past several hours. His temp is 103 F, BP is 110/70, pulse is 90/min and resp: 18/min. Exam shows a tender iliac fossa mass palpated on the right side; remaining abdominal exam shows no rigidity or guarding. Which of the following is the most appropriate next step in management?
A. Immediate Surgery
B. IV hydration, erythromycin, and metronidazole
C. IV hydration, tetracycline, and metronidazole
D. IV hydration and cefotetan
E. Ciprofloxacin and vancomycin
F. IV hydration and observation
Does he have appendicitis? What makes you think so or what makes you rule it out?
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| robin082006
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D. IV hydration and cefotetan
intraabdominal abscess
he may have appendicitis before but no treatment-->abscess
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| DrVirgo
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D is right.
complicated appendicitis.
Perforation with a localized inflammatory infiltration is likely to be present.
Patients who present more than 5 days after the onset of symptoms, and have localized RLQ findings should be treated with IV hydration, antibiotics, and bowel rest. Antibiotics should cover enteric gram negative organisms and anaerobes...
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| usmle12
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plz dr virgo could u tell difference btw complicted appendicites mass n abscess and their presentation also their brief treatment..
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