Case Study 25: Right Lower Quadrant Abdominal Pain - CRASH! Medical Review Series

(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

[Ka]

Been a while since i have been here good to see you

[LoriJMarshall]

I have so much fun with your case studies. I was a Medical Laboratory Tech and enjoy testing my memory. You have reminded me of things I once knew and educated me of things I didn’t know. I love the study of human pathology. Always have - always will. 😊

[PassportDialectic]

My Symptoms point to IBS, but I’m a veteran and expat living in Argentina. Med service is… complicated. 100% medical with the VA and sitting here undiagnosed in Buenos Aires. Talk about bad luck.

[creneemugo]

UPDATE:

Also, try distilled water. I highly recommend that everyone stop drinking tap and bottled water until you heal... The tap and bottled water are very acidic and the govtmnt does not regulate it. I completely stopped drinking it and I only drink distilled water and it healed so many ailments of mine... I was having chronic inflammation. Distilled water is available in any store in the water section.

If you drink distilled water people claim that you will not get the needed minerals found in regular water... but you can compensate buy buying and adding trace minerals to the water....or dropping a pinch of pink Himalayan salt in your gallon jug of distilled water. Pink Himalayan salt may also heal any infection in your body... Even better would be to buy a distiller machine and make your own distilled water but I was able to heal my body drinking Crystal Springs store-bought water and dropping himalayan pink salt (just a pinch) in the gallon container).

I am feeling 100%!!

[brookekerimt]

Wow the shocking difference between the care you receive in Canada versus your suggestions is mind blowing. I had to make three trips to the Emergency department before being diagnosed with cholecystitis. Unfortunately because it had been so long it was no longer safe to operate and I had to be admitted for IV antibiotics for several days prior to surgery. If you’re interested in making videos about what NOT to do i’d be happy to share more details!

[Dobrojuto.yt-]

I have last two years upper right abdominal pain only at night, allmost always at 3-4 am. That pain is about 3-5 times at one month. I figured when i press my lower abdomen( when i have pain) pain in right upper becomes more evident.
Im 45 I didn't lose weight last years, no strange colors stool or urine.
My mum died from cholangiocarcinoma.
What this could be?

[woloabel]

(On Wednesday of February 22, 2023). On the Matter of Right Lower Quadrant Abdominal Pain (CRASH! Medical Review Series: Case Study 25): 1) Vitals: 1) BP is 132/90 (Elevated); 2) HR is at 101 (Elevated); RR is 14; Temperature is at 101.0 Degrees Fahrenheit (A Febrile Quantity; Fever); and Saturation is at 99% at Normal Circulation/Nasal Canula (NC); 2) Physical Examination (Px): 1) General Finding is Subject in Visible Distress and/or Pain; 2) Chest/Lungs are Clear on Auscultation; 3) CV is RRR and Absent of Murmurs or Abnormal Sounds; 4) Abdomen Examination has 1) Rovsing's Sign Positive (LLQ Palpation Eliciting RLQ Pain and Pathognomonic of Acute Appendicitis) and 2) Guarding/Rebound Tenderness; 3) There is Diminished Bowel Sounds and 4) Non-Distended Abdomen otherwise; 5) Rectal Investigation is Normal Tone with Brown Stool (Occult Blood Negative); 6) Genitalia Examination yields Normal Female External Genitalia, a Normal Uterus, and Absent Adnexal Masses and Non-Tender; 3) Signs And Symptoms (SSx): 1) Nausea/Vomiting (Emesis), 2) Fever (> 98.7), 3) Tachycardia (> 100 BPM), and 4) Halitosis or Foul Breath (Fetor due to Bacterial By-Products); 5) Constipation (Gastrointestinal Involvement); 6) Diarrhea; 7) Polyuria (Irritation of the Bladder by the Inflammation of the Appendix); 3) Differential Diagnosis (DDx): 1) Acute Appendicitis (A Common Hospital Emergency) is Inflammation of The Appendix and usually due to Obstruction Therein by a Fecalith; 2) Acute Cholecystitis is RUQ Abdominal Pain and Post-prandial Distress Common; Murphy's Sign Positive (Palpation of Right Subcostal Area Just After Exhalation of the Subject) and RUQ Imaging shows Stones; 3) Acute Peritonitis has many Aetiologies Possible but is generalized Abdominal Pain with More Severe Symptoms (Generally a Complication of an Abdominal Infection); Septic appearance; 4) Nephrolithiasis is Kidney Stones and History Positive while Pain Profile is Groin Radiated Pain and Flank Pain Positive; UA shows RBCs with a Normal CBC; 5) Ectopic Pregnancy (Urine B-hCG Hormone Positive); Extrauterine Pregnancy and ultrasound diagnosis; 6) Ovarian Torsion has a n Afebrile Profile with A Palpable Adnexal Mass and Trans-Vaginal Sonography Positive (Radiologic Investigations); 7) Mittelschmerz is mild, recurrent and diffused Abdominal Pain without Systemic Features (SSx); 8) Endometriosis will have a Cyclical Pain Profile with History of Dysmenorrhea and Dyspareunia; 9) Pelvic Inflammatory Disease (PID) has a History of STDs with Cervical Tenderness with Motion; Pain is Noncyclical; 10) Tubo-Ovarian Abscess is Positive for History of STDs and/or PID with Cervical Motion Tenderness along with an Adnexal Mass; 4) Diagnosis (Dx): 1) Because of the Standard of Care For Acute Appendicitis is Laparoscopic Appendectomy due to Known Complication(s) if Surgery is Not Performed, Initial Supportive, Pre-Operative Procedures of Stabilization: a) Intravenous Morphine (For Sharp otherwise Unmanageable [Severe] Pain) is An Opium-Based alkaloid with Characteristic Analgesia (Pre-Operative Priming); Hyposensitivity of Subject is Mandatory (Known Morphine Allergies) before any Infusion Thereof; b) Intravenous Normal Saline (NaCl at 0.9% Normotonic [Isotonic] Solution); c) IV Promethazine (Anti-emesis or Phenothiazines Antihistamines of 1st Generation, Drug Class); 2) Urine Qualitative B-hCG (Pregnancy Test via Syncytiotrophoblastic Hormone Assessment) because of Procedure of SOC and Teratogenesis Contraindication in Ionizing Radiation Exposure of Radiology (Radiographic Investigations Warrant Ultrasound Imaging or MRI); 3) Complete Blood Count (CBC) shows Leukocytosis of Neutrophil Predominance (Suggestive of Ongoing Bacterial Infection) at WBC 14, 300/mm3; Hgb is at 13.5 mg/dL; Hematocrit at 41.2%; Platelets are at 235, 000/mm3; 4) Basic Metabolic Panel (BMP) is WNL; 5) Urinalysis (Urine Investigations) yields Negative Nitrites and Esterase (90% Sensitivity for Urinary Tract Infection) without RBCs (No Occult Hematuria or Gross); 6) Because Gynecologic Infections Have been Ruled out, Acute Appendicitis Stands High in Screening Testing and Confirmation is Warranted via Computed Tomographic Visualization where Structure Dilation at 8mm and Wall Thickening and Enhancement, along with an Appendicolith Visualization and Hypolucency of Appendiceal Surrounding Adiposity is characteristic Morphology of an Inflammation Process Therein (Also Malignancy And Trauma); Differential Diagnosis of Adjacent Fat Stranding is 1) Diverticulitis, 2) Epiploic Appendagitis, and 3) Omental Infarction which are all Negative and Acute Appendicitis is therefore Confirmed; 5) Treatment (Tx): 1) Pre-Operative Orders: a) IV Cefoxitin (Second Generation Cephalosporin [Second-Generation cephamycin Antibiotic ] for Antibiotic Prophylaxis); b) Nil (Non) Per Os (NPO); c) IV Dextrose 5% 1/2 Normal Saline For Maintenance Fluids; d) Type and Crossmatch (For General Surgery Transfusion Possibility otherwise SOC); e) PT/PTT; 2) General Surgery Consult for Surgical Treatment (Appendectomy); 3) Urgent Laparoscopic Appendectomy (STAT); 6) Management (Mx): 1) IV Pain Management is Perhaps the Most a Primary Care Physician and/or Emergency Medicine Physician can do Initially for the Subject; 2) Gestation Status Assessment if Positive CT Imaging is Teratogenic (Ionizing Radiation is also Carcinogenic) and Contraindicated for both Pediatric/Obstetric Subjects and During Gestation (Fetus Abnormality and A Liability Beyond Debt Reparations); Alternate Indication is Imaging with Ultrasound, the best and non-pathologic Imaging Methodology, or Magnetic Resonance Imaging (MRI) as an Alternate therein; 3) Urology Diagnoses Rule out in the Diagnostic Process; Goodness my first Acute Appendicitis. Not Really, Just kidding. Ruptured Appendicitis quickly Progresses to Acute Peritonitis, Sepsis and there might have been an Underlying Epiploic Appendagitic Disease Process mostly undetectable due to Ultrasound anomalies. MD Paul Bolin, es gut ist zu vermehren Gesundheit und vernichten Krankenheit aber Manchmal man will nicht besser. Heil!

[earthsendangered]

It may be parasites. I took medicine for parasites and the pain and stuck poop filling went away. I took durvet ivermectin for horses (apple flavored) LOL. It works on humans too.

[PassportDialectic]

9hrs? Try 9 months. That’s where I’m at.