Surgery
14 years old female came with periumbilical pain shift to the right with right tenderness anorexia mild…
14 years old female came with periumbilical pain shift to the right with right tenderness anorexia mild diarrhea + dysuria, no vomiting no previous similar history no fever on exam abdomen soft but right tenderness increase with cough, Dx?
Explanation
Core Concept: Acute Appendicitis. Inflammation of the vermiform appendix. A pelvic appendix can irritate adjacent structures like the rectum or bladder, causing atypical symptoms like mild diarrhea or dysuria.
Clinical Presentation:
- Visceral periumbilical pain that migrates to the somatic right lower quadrant (RLQ).
- Anorexia, nausea, and localized peritonitis. Pain exacerbated by coughing (Dunphy's sign) indicates parietal peritoneal irritation.
Diagnosis:
- First-line: Clinical evaluation (Alvarado score) and abdominal/pelvic ultrasound (preferred in pediatric and female patients to avoid radiation and assess gynecological organs).
- Gold Standard: CT scan of the abdomen and pelvis with IV contrast (if ultrasound is equivocal).
Management:
- Acute: NPO, IV hydration, analgesia, and prophylactic IV antibiotics.
- Definitive: Laparoscopic appendectomy.