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Right Lower Quadrant Pain SYB January 24, 2008 Julianne Lauring

Right Lower Quadrant Pain SYB January 24, 2008 Julianne Lauring. 43 yo male presents to the ED with RLQ pain. Inflammation. Inflamed Appendix. Fecalith. Appendicitis. 7% of the US population Incidence of 1.1/1000 people per year

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Right Lower Quadrant Pain SYB January 24, 2008 Julianne Lauring

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  1. Right Lower Quadrant Pain SYB January 24, 2008 Julianne Lauring

  2. 43 yo male presents to the ED with RLQ pain Inflammation

  3. Inflamed Appendix

  4. Fecalith

  5. Appendicitis • 7% of the US population • Incidence of 1.1/1000 people per year • Mortality of 0.2-0.8% due to complications, not surgical intervention • Mortality increases to 20% in patients over 70 • Perforation is highest among patients younger than 18 years and over 50 years • HX: • Only 50% of patients present with classic history of anorexia and periumbilical pain followed by nausea, RLQ pain, and vomiting • Migration is the most discriminating factor • Vomiting before pain suggests obstruction • Physical: • RLQ tenderness is present in 96% of patients but this is nonspecific • Minority of patients have Rovsing sign (RLQ pain with palpation of LLQ), obturator sign (RLQ pain with internal rotation of flexed hip), and the psoas sign (RLQ pain with hyperextension of the right hip) • Cause: Obstruction of lumen • Fecaliths • Lymphoid hyperplasia • Other less common causes include parasites, foreign materials, TB, and tumor

  6. Appendicitis: Imaging • CT– Imaging modality of choice • US – Best for pregnant women and children because of lack of radiation exposure • Abdominal Radiography – Consensus is that it is insensitive, nonspecific, and not cost-effective • Barium Enema – No role in era of US and CT due to high incidence of nondiagnostic results, radiation exposure, insufficient sensitivity, and invasiveness • Radionuclide Scanning – No role due to 5 hour acquisition time and lack of availability despite high sensitivity (98%) • MRI– single study of 51 patients shows high sensitivity and specificity but expense and acquisition time make CT a better choice

  7. References Emedicine - www.emedicine.com/emerg/TOPIC41.HTM “Appendicitis, Acute” by Sandy Craig, MD

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