Acute Appy

It is incredibly satisfying to find a case that is a classic textbook diagnosis. A 40 year old man with no significant past medical history comes into the emergency department with acute onset periumbilical pain that started yesterday associated with anorexia, nausea, vomiting. Today, the pain progressed and migrated to the right lower quadrant. On my exam, he had tenderness in the epigastric and RLQ areas and pushing on the LLQ made the RLQ pain worse. His pain was worse when I let go than when I pushed in. I noted that his abdominal muscles tightened when I pushed down. As is often the case, we still pursued a CT scan which showed acute appendicitis.

It was really wonderful to make the diagnosis. In the emergency department, a dozen or two dozen things can cause abdominal pain and many times, we don't have a good answer. But here, the history and physical exam told me everything. The ED is very satisfying with that respect; we are the first pass to turn an undifferentiated patient into a presumed diagnosis.

Image of acute appendicitis from Wikipedia shown under Creative Commons Attribution Share-Alike License.