A 30 year old female comes to your OPD with pain in her right loin and nausea since 2 days.

 A 30 year old female comes to your OPD with pain in her right loin and nausea since 2 days.

She has a fever of 37.2 C. The pain is dull in nature and continuous .

She denies any vomiting or retrosternal burning and there is no constipation.

The pain does not radiate to the back .

She drinks 2 -3 glasses of water everyday.

You decide to investigate her further.

1 . Which further test would you like to conduct :

2 . What are the differential Diagnosis in this case ?

3 . What are the findings on Abdominal ultrasound ?

4. How will you manage this patient ?

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1 .Which further test would you like to conduct :

Full blood count

Urine Routine examination

Abdominal ultrasound

Take a detailed Gyne History to exclude pregnancy or other gyne related problems

Her White cell count was found to be raised on FBC results and urine R/E also shows numerous pus cell.

2 . What are the differential Diagnosis of in this case ?:

Urinary Tract Infection

Pelvic Inflammatory disease

Acute Pylonephritis

Renal stone

Pregnancy / Ectopic pregnancy

Acute Appendicitis

3 . What are the findings on Abdominal ultrasound:

Thickened appendix wall 12 mm

Most likely Diagnosis :

Acute Appendicitis

4.Management:

Nil by mouth

Urgent Surgical Review

Aim for appendectomy

Give iv fluids , intravenous empirical antibiotics

Cefuroxime 850 mg tds

Metronidazole 500 md tds

Antiemetics

Intravenous fluids

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