Can you make the diagnosis?

A 26-year-old female patient presents to the Emergency Department with abdominal pain that has been present for 12 hours.  She has had vomiting but has no diarrhea.

The patient has no past history of medical problems, and has never had a surgery.

The patient states the pain started in the middle of her stomach, by her belly button, but now hurts worse on her right lower side.

The Emergency Department nurse checks the patient’s vital signs.  The patient’s temperature is 98.9, and blood pressure is 124/84.  Her pulse is 113.

The Emergency physician examines the patient, and orders laboratory tests.

A complete blood count shows that the white blood cell count (WBC) is elevated at 13,000 (normal 5000-10,000).   The urinalysis shows 5-10 WBC and no blood cells.   A pregnancy test is negative.

If the physician orders a CT scan of the patient’s abdomen, what will it show?

1.  Ulcer
2. Kidney stone
3. Appendicitis
4. Gallstones

 

 

Answer:

If you guessed 3.  Appendicitis, you are right!

Appendicitis pain usually starts around the belly button (umbilicus), and then moves to the right lower quadrant of the abdomen.  It is usually, though not always, associated with vomiting.  Some patients will have a low-grade fever.

An ulcer usually causes pain in the upper abdomen, and can cause blood in the vomit or stool.  Kidney stones would usually show blood cells on the urine testing, and typically cause pain more in the flank/back area, though that can vary.   Gallstone pain would be in the right upper quadrant of the abdomen below the ribs.