Mr. Jackson presented with abdominal pain and was diagnosed with appendicitis. His symptoms of burning pain worsened by straightening up and better when bending forward along with anorexia and nausea raised appendicitis as a top differential diagnosis. Laboratory tests showed an elevated white blood cell count indicating infection or inflammation. A CT scan revealed an enlarged cecum with a small fluid collection consistent with appendicitis. The patient was diagnosed with appendicitis based on his symptoms, lab results, and CT findings while other potential causes like bowel perforation or urinary calculi were ruled out.

1. [From 10$/Pg] Samantha Chanel De Vera
[From 10$/Pg] Samantha Chanel De VeraSamantha Chanel De VeraPosted DateMar 24,
2022, 12:00 AMUnreadReplies to Megan MarrMr. Jackson is an 18-year-old that presented
with complaints of recent onset of abdominal pain that started 5 hours prior to admission.
He described the pain as burning that is worsened with straightening up and is better if he
bends forward. The patient also complained of anorexia, nausea, bowel irregularity but
denied any fever, chills, or vomiting. My differential diagnoses were appendicitis, urinary
calculus, and a bowel perforation. On examination, the patient vital signs were
unremarkable; however, he was positive for Rovsing sign, but his abdomen was soft. His
CBC showed a WBC of 17,900, indicating an infectious or inflammatory process. In an
otherwise healthy adult, laboratory tests should generally only be ordered to rule in a
clinically suspected diagnosis or to assess a patient with an acute abdomen of unclear
etiology(Kendall & Moreira, 2020); this is why I only ordered CBC initially. Rigid abdomens
are most often due to perforation or obstruction, but this patient’s abdomen was soft with
some tenderness(Kendall & Moreira, 2020); therefore, bowel perforation is at the bottom of
my list with my differentials. I also ordered urinalysis, which only shows some hematuria.
Urinalysis can sometimes be misleading. The presence of pyuria, proteinuria, and hematuria
suggests UTI diagnosis, but these findings may also be present with acute appendicitis or
any inflammatory process occurring adjacent to either ureter(Kendall & Moreira, 2020). I
did not order KUB because random use of plain radiographs to assess general abdominal
pain is an extremely low-yield practice, and only a small percentage is abnormal. CT is the
study of choice in the evaluation of undifferentiated abdominal pain. Approximately two-
thirds of patients presenting to the ED with acute abdominal pain have a disease that CT can
diagnose(Kendall & Moreira, 2020). Thus, I ordered an abdominal CT. His abdominal CT
also shows that the cecum is enlarged and has a small fluid collection. CT scan usually
shows inflamed, a distended appendix that fails to fill with contrast or air, appendicolith,
mural thickening, pericecal fluid collection, and periappendiceal fat stranding for acute
appendicitis coinciding with the result of his CT scan(Cappell, 2017). Thus, I ruled out bowel
perforation, urinary calculi, and diagnosed this patient with appendicitis.ReferencesCappell,
M. S. (2017). Large bowel disorders. In S. C. McKean, J. J. Ross, D. D. Dressler, & D. B.
Scheurer (Eds.), Principles and practice of hospital medicine (2nd ed., pp. 3051–3090).
McGraw-Hill.Kendall, J. L., & Moreira, M. E. (2020, December 29). Evaluation of the adult
with abdominal pain in the emergency department.

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