robin082006
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A 16-year-old high school student is brought to the emergency department because of severe right lower quadrant abdominal pain. She was at volleyball practice when she suddenly doubled over in pain. She has no significant past medical history and had a few episodes of right-sided abdominal pain in the last week. She says that the earlier episodes of pain were much less severe. She is sexually active with one partner, her boyfriend, and they use condoms for birth control. Her temperature 38.8 C (101.8 F), pulse is 90/min, blood pressure is 120/85 mm Hg, and respirations are 14/min. On physical examination she appears very uncomfortable and is in obvious pain. Abdominal examination is significant for focal exquisite tenderness and guarding in the right lower quadrant. Leukocyte count is 11,200/mm3 with 69% segmented neutrophils and 2% band forms. The most appropriate test or study at this time is
A. lower gastrointestinal barium enema
B. ultrasonography of the appendix
C. ultrasonography of the pelvis
D. upper gastrointestinal barium study with small bowel follow through
E. urinalysis
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| cirus
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Ans is B
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| Sayulita
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it sure sounds like an appendix
B
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| otromiguel
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Ans B.
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| virgola82
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I would say B too
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| Justice
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It looks like appendicitis, but I have a feeling that this is renal colic due to stone dislodging/passing... Note history of recent pain... In addition, pain usually migrates from periumbilical area into RLQ (visceral to somatic transformation)... In addition, USG wouldn't be of great diagnostic help for acute appendicitis unless peritoneum is involved (again, unlikely with this longevity of the pain). I would go with E. urinalysis
Finally, it may be an ovarian torsion, and if so, we have to go with (C), not (B)
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| robin082006
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Answer is B
This is appendicitis,
We order sonogram first, if negative-->CT
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| Tuscani
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is not a clear appendicitis presentation!
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