Renal colic mimics
Some mimics of renal colic that may arrive at the ED include: upper UTI’s, ectopic pregnancies, ovarian torsion, adnexal masses, testicular torsion, acute aortic syndromes, renal artery aneurysms, renal infarction, splenic infarction, bowel obstruction, diverticulitis, appendicitis, biliary colic, cholecystitis, acute intestinal ischemia, pneumonia, pulmonary embolism, retroperitoneal hematoma, iliopsoas abscess. Focused history and physical exam […]
The Pregnant Peritonitis
The gravid uterus can mask the signs of peritoneal irritation (guarding, rigidity and rebound tenderness) by preventing the inflamed organ from contacting the peritoneum. Due to increased white blood cells that naturally occur during pregnancy, leukocytosis is not helpful in identifying acute pathology. A relative increase in blood volume can delay the development of tachycardia […]
Appendicitis
There is no individual sign or symptom that can reliably exclude appendicitis in any patient. (Vissers RJ, 2010) The three most valuable historical clues include RLQ pain, migration of pain from the periumbilical region to the RLQ, and pain occurring prior to vomiting. Symptoms helpful in excluding appendicitis include previous histories of similar pain and […]
Dear Surgeons…We are done ordering WBCs and CR(A)Ps for your Appendicitis
No WBC count or CRP level can safely and sufficiently confirm or exclude the suspected diagnosis of acute appendicitis in patients who present with abdominal pain of 5Â days or less in duration.
Why on earth does radiology insist on oral contrast?
Small Bowel Obstruction – Oral contrast is contraindicated in suspected in SBO. IV contrast is preferred, but not required. Suspected appendicitis – Oral contrast is not required, but may be beneficial in extremely thin individuals (e.g. BMI < 18), or non-obese children. Suspected diverticulitis – Oral contrast is not required Unclear etiology – PO contrast […]
Appendicitis Clinical Decision Rules
In Appendicitis, NOTHING is better than your clinical experience and acumen and when the surgeon asks you what the WBC is, remember…’The WBC count still is the Last Bastion of the Intellectually Destitute!’
