there is no first test.... I am not sure what Saca's diagnosis is yet so don't want to go into too many details.

in short, you obtain a history that should make you suspicious of an appendicitis and then look for localized right lower quadrant tenderness if its early...can be diffuse pain if its late. The one finger tenderness at mcburney's point is pretty consistent especially if its a male patient.....

so I would say the diagnosis is made on history and tenderness, not necessarily rebound.

doc t.

Thank you very much Doc. T.
Sorry for the hijack, Sacamuelas, back to your thread.

Solid

HOT DAMN!! that is a great start
 

Alright! this is exactly what I was hoping for when I started this thread. Everyone can now see how a clinician's thought process works. Thanks NDD, Doc T, and others. I will be printing this thread so that I can answer all the info for the questions and exam you have stated you would do.

Yes, Kyo, I figured out what you were wanting, but I couldn't tell if you wanted the info derived by questioning alone or in conjunction with an actual abdominal exam by you... Since you didn't tell me to do an exam on his abdomen, I didn't give you the benefit of the doubt. Now that you have clarified what you want/would do, your exam results info may just vary from what he "thought and told you" and therefore told you. haha)

Back in a few with info for your guys/ladies...

I know you didn't just call me a clinician?

How Many stars does that make by the name "JawBreaker" on that list of yours?:D

LOL... I am alright, my six is covered.. you guys took the path that I wanted you to follow in this thread. Are you sure you haven't walked into a SACA ambush? LOL


Quick note for Tuuka-

Doc T has of course covered most of this info. For you medics to be, here is a brief diagram that covers what Doc T said about Mcburney's sign... (see diagram at the end of this post)

In our case we are working:

palpation/percussion exam reveal the following:

• pt has moderate tenderness to direct palpation around umbilicus
• pt's abdomen is rigid in RLQ w/associated severe tenderness upon palpation of RLQ.
• "Mcburney's point", however, is not specifically more tender than any other are within the RLQ
• Quick note about potential palpation/percussion exam findings:
  ------Rovsing sign (ie, RLQ pain with palpation of the LLQ), obturator sign (ie, RLQ pain with internal rotation of the flexed right hip), and psoas sign (ie, RLQ pain with hyperextension of the right hip) are present in a minority of patients with "our TS's condition".
  ***None of these findings were observed when we examined our patient.
  
• guarding present upon exam
• no rebound tenderness noted upon exam

Other items/info requested:

• Patients pain seems to increase when standing/walking
• pt was taking IBU 800, TID prn for sprained ankle beginning two days prior.
• stools regular and WNL per patient's recollection. Last known bowel movement 24 hours ago.
• Pain getting worse compared to when first noticed
• no radiating of pain described by patient, however, as it has worsened , he states it could hurt in his back as it hurts all over and is giving him worse nausea.
• Pain is worsened by walking/standing verses supine
• WBC?? You don't have access to this info in the jungle NDD., however, your jedi powers indicate that the count is elevated though. (ONLY NDD can use this info... none of you would have this ability except him) LOL
• Pt reports similar pain in the past, not as severe, and resolved in its own after an hour or so.
• Pt states his nausea came before pain, and that his appetite has been minimal for the last 48 hours for unknown reason.

Alright.. I think that covers all the wanted exam techniques and questions to ask the patient. Now that you have this info... Any more questions? Do you have a guess as to Diagnosis? What have you now ruled out ( which is just as important since you must do this before you can make a legit Dx)?

18Ds have the capabilities of doing WBCs in UW environments. or did in my day.

In that case.. WBC(/mm3) count 15,000.:cool:

Is he experiencing any heartburn?

a few more questions...

is he a heavy drinker ( i know...its all relative)
do jedi powers extend to other labs?
or xray vision?

doc t.

LOL.... no more jedi powers

-He is not a "heavy" drinker.
-Only NDD has jedi powers... labs are not available ( even IF you could perform the test NDD. LOL)
-standard KUB x-rays show the following only 10% of the time(according to what little I know from research). I shouldn't post this but what the hell... most will not know what it shows anyway, and even you may not be able to tell due to the poor resolution of the copy.

Back later tonight after my crawfish boil/party....

Doc T.. Pm incoming late tonight or tomorrow morning about this thread. I want to discuss certain things about this one. Make sure I have given enough info without making it to difficult in your opinion. :D

Until then, I'm looking forward to hearing WAG's and why. Some have already ruled out some possibles with their professional questions.

again, hint..hint... I don't post thread topics that are extremely rare events unlikely to be seen by the future/current SF docs. This is something that I now KNOW has happened and will possibly be faced by you in your career. Almost like I am psychic or something... LOL

Is this the appendix? (red circle). If it is I don't think it looks right. But then, what do I know?

Is he passing a more gas than normal? Does it smell worse than normal?

This sucks not nowing enough to ask the right questions.

well, now I know the diagnosis based on the Xray... and an appendix in and of itself will not show up on a plain xray.


will wait and see what others think.


doc t.