Appendicitis and Abdominal Pain
Prereading :
PEM Pearls : The nonvisualised appendix quandary on US
| CHQ Abdominal Pain Guideline |
Workbook Questions :
Case 1
A 13-year-old girl who is bought to ED by her mother has a 2-day history of abdominal pain and vomiting. Initially the pain was quite crampy but now is there all the time. She has had 2 vomits but normal bowel motions.
A 9-year-old girl presents to ED with her very anxious mother with 6 months of abdominal pain. There is occasionally associated nausea but no vomiting or changes to her bowels. She has no urinary symptoms, minimal appetite but no weight loss. She has presented to the GP several times and has had a FBC, ELFTs, CRP and Urine MCS this week that are all normal.
Case 3
A 5-year-old boy presents after not having opened his bowels for 6 days. His father reports small solid stools every 4-6 days. Abdominal exam reveals a palpable mass in the LLQ and you suspect he has constipation
Case 1
A 13-year-old girl who is bought to ED by her mother has a 2-day history of abdominal pain and vomiting. Initially the pain was quite crampy but now is there all the time. She has had 2 vomits but normal bowel motions.
- Before you start your history and examination you notice she appears to be in pain and reports 8/10 discomfort, what analgesia would you prescribe and what is the dose?
- What other questions would you like to ask to complete your history?
- What features would you look for on examination?
- Her observations are as follows: Temp 37.9, HR 90, RR 16, CRT < 2 secs, weight 64kg. On examination she appears to be tender in the RLQ.
- What differential diagnoses are you considering at this point?
- What investigations might you consider and why?
- Urine: 20 leucs, no bacteria seen
- FBC: Hb 112, WCC 16.3, Plts 210
- CRP: 16
- USS: Normal ovarian pathology, appendix not visualized
- What are your management options at this point? What is her likely disposition?
A 9-year-old girl presents to ED with her very anxious mother with 6 months of abdominal pain. There is occasionally associated nausea but no vomiting or changes to her bowels. She has no urinary symptoms, minimal appetite but no weight loss. She has presented to the GP several times and has had a FBC, ELFTs, CRP and Urine MCS this week that are all normal.
- Are there any other things you want to ask on the history specific to this case?
- With no further positives in the history and a normal abdominal examination, what is your current list of differential diagnoses?
- Would you consider any other investigations today or further investigations and follow up in the community?
Case 3
A 5-year-old boy presents after not having opened his bowels for 6 days. His father reports small solid stools every 4-6 days. Abdominal exam reveals a palpable mass in the LLQ and you suspect he has constipation
- How might you manage this child and how should he be followed up? What information will you give to the parents about both diet modifications and pharmacological treatment