abdopain_rif
RIF pain in the ED
right iliac fossa pain:
differential diagnosis:
initial Mx in ED:
urgent pregnancy test if not already known to be pregnant
examine inguino-scrotal region to exclude hernia/testicular torsion
FWT urine:
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if paediatric, blood tests not usually needed, consider US if female over age 8-10yrs
if adult then:
FBE + HCG if female aged 13-50yrs.
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if possible ovarian cyst or torsion of ovary (usually sudden onset pain) then pelvic US
if it seems more likely to be
appendicitis, contact surg. reg
pain initially epigastric and migrated to RIF with anorexia, nausea +/- low grade fever
max. tenderness over McBurney's point
+/- Rovsing's sign - rebound tenderness LIF
+/- psoas sign (pain on passive extension of the right hip) - esp. likely in retrocaecal appendicitis
+/- obturator sign (pain on passive internal rotation of the flexed right thigh) - esp. pelvic appendicitis
remember, pelvic appendicitis may have few abdo signs and present with
diarrhoea
if more likely to by gynae and pain not settling then contact O&G reg.
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suspect if change in bowel habit, tenesmus, esp. if fever but remember WCC only raised in 36%
consider CT abdomen with contrast but check renal function first and ensure not on metformin before using iv contrast
if sudden severe lower abdo. pain, becoming generalised with toxicity/peritonitis consider erect CXR to exclude perforated bowel secondary to diverticulitis
if working Dx is diverticulitis, then Amoxyl + Flagyl, liquid diet for 48hrs, if more than mild, will need admission.
if female and post-partum or post gynae surgery then consider pelvic vein thrombosis:
abdopain_rif.txt · Last modified: 2018/04/03 17:55 (external edit)