“Upset stomach” … Case Conclusion October 7, 2011
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The patient in the second case presented very atypically. The emergency clinician was going to send her home with a UTI, but luckily she started vomiting while in the ED and then spiked a fever. A CT with rectal contrast demonstrated an enlarged, necrotic appendix, and the patient underwent laparoscopic appendectomy without complication. This patient was a reminder that elderly patients with appendicitis often present atypically and that a high clinical suspicion and a low threshold to order imaging in this patient population is warranted. Furthermore, urinalysis may demonstrate nonspecific inflammatory signs in an appendicitis patient of any age.
Congratulations to Dr. Dube, Imad, Dr. Orecchioni, Dr. Shafey Dr. Zubair — this week’s winners of Emergency Medicine Practice’s “Evidence-Based Management Of Suspected Appendicitis In The Emergency Department!” For an evidence-based discussion of the most current findings in regard to the diagnosis of appendicitis in the emergency department (ED) (with particular attention towards elucidating the elements of history, physical examination, and laboratory testing that will most benefit the emergency clinician faced with the dilemma of diagnosing possible appendicitis), read this issue.
“Upset stomach…” September 20, 2011
Posted by ebmedicine in Abdominal Emergencies.22 comments
A 62-year-old female presents with an “upset stomach,” suprapubic discomfort, and dysuria over the last 12 hours. She said this feels similar to UTIs that she’s had in the past, so she took a ciprofloxacin this morning with no relief. She is afebrile with stable vital signs and a soft abdomen with mild suprapubic tenderness with trace rebound, no guarding. Labs returned with WBCs of 10 and RBC of 5, with negative nitrates, bacteria, and squamous cells. She states that she still feels “uncomfortable in her stomach” but otherwise is without complaints.
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