Comments on: Appendicitis is Tricky

By: Anonymous

Anonymous — Thu, 18 Dec 2008 16:12:48 +0000

14 year old presented with sudden onset RLQ pain and nausea. The first US neg, CT with contrast with a questionable 2mm vague finding on CT scan, radiologist can not decide if fecalith or contrast since so small, otherwise, normal CT. Surgical team will not consider surgery since US and CT look to be normal except for nonspecific findings Second US obtained appendix not visualized. WBC neg, UA and HCG neg. Is is still possible the 14 year old could have appendicitis? She continues to have RLQ pain over Mc Burney’s point and intermittent nausea.

By: flowerelena

flowerelena — Sat, 10 May 2008 07:51:49 +0000

Great blog!

Indeed appendicitis is tricky. 2 weeks ago I was forced to go to the doc’s. Presented with mild fever, sever pain in RLQ, loss of appetite, and pain behind belly button. Every time the doc pushed my belly I would scream. Off to the lab I went to get a UA, CT scan, and a CBC.

All the tests came back normal. No one knows what happened. The tests saved me from surgery that day.

Fast forward to now…sudden pain in RLQ again and screaming pain when belly is pushed on. Who knows what it is. Maybe I’ll get told I have virus again.

By: hannah

hannah — Thu, 13 Dec 2007 07:24:20 +0000

I was sooooo close to being discharged with appendicitis. C-scan was negative; intense pain & vomiting relieved after my co-occuring impaction was dealt with; no fever. The only thing was my damned’ high wbc. So the other ER doc on call goes: “Well, hell, she has insurance and if it’s going to happen, it’ll happen to a doctor’s kid. Take her to surgery.” My appendix ruptured as the surgeon was taking it out. :O

By: Ten out of Ten

Ten out of Ten — Tue, 11 Dec 2007 18:36:13 +0000

Nurse K — Rovsing’s sign.

WhiteCoat — Feel free to drop by and rant anytime. People have got to realize that a test is not validated by its result.

By: health- self assessment « Karinajadhav’s Weblog

health- self assessment « Karinajadhav’s Weblog — Tue, 11 Dec 2007 14:35:28 +0000

[...] self assessment blogger ten out of ten is highlighting the the problems with online self assessment. The problem is unlike medical [...]

By: If the Disease Doesn’t Kill Ya, the CT Scans Will « WhiteCoat Rants

If the Disease Doesn’t Kill Ya, the CT Scans Will « WhiteCoat Rants — Tue, 11 Dec 2007 03:28:08 +0000

[...] actually believe that 30 percent of CT scans are “unnecessary,” on how many of the above cases would you have prospectively ordered CT scans? All of them, right? After all, they were all [...]

By: WhiteCoat

WhiteCoat — Tue, 11 Dec 2007 03:18:15 +0000

Hmmmm. Which one of these three would have been included in the 30% of CT scans that are “overordered” by emergency physicians?
Oops. Right. They were all appropriate because they showed something. Its the other dozen or so normal scans in patients with RLQ pain that we’ll get bashed for.
Sorry about bringing my rant to your blog. It’s just cases like this that scare me and people telling us that we order too many tests that just tick me off.

By: Nurse K

Nurse K — Tue, 11 Dec 2007 02:23:18 +0000

I got one the other day who c/o LLQ abd pain, but –oh–when you push on the left side, it makes the right side hurt, but palpating the right side didn’t really hurt that much. Eventually, she got out her textbook and decided the right side hurt more.

By: Kate

Kate — Mon, 10 Dec 2007 23:58:22 +0000

I am hoping that in the future we will be able to prophylactically laser-ablate the appendix on every school-age child.

In the meantime, it is extremely difficult to get anyone to operate on classical presentations without a catscan in my hospital. Worse yet, is the contrast-waiting game when the scan comes back as “appendix not visualized”. Surgery tends to admit and sit on those at our place and see if their abd exam changes.

By: Ryan

Ryan — Mon, 10 Dec 2007 22:11:53 +0000

A couple of weird ones I’ve had recently:

54 year old woman with syncope, no abdominal pain initially, negative syncope workup, but, “now I’ve got this pain down here…”

33 year old woman with a chief complaint of depression for 3 months since her divorce, and also a few days of abdominal pain (normal white count).