Appendicitis and Differential Diagnoses

Introduction

Jerome Cauthen is a 22-year-old male who has complaints associated with abdominal pain that started eight hours ago. The pain is located around his navel and epigastrium. To conclude regarding the final diagnosis, it is important to identify differential diagnoses and focus on the abdominal assessment to confirm the conclusions.

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Differential Diagnoses

Depending on the observed symptoms and signs, it is possible to determine the following differential diagnoses: appendicitis, acute pancreatitis, gastritis, gastric ulcer, and cholecystitis. The symptoms of appendicitis as the inflammation of an appendix can include abdominal pain, nausea, vomiting, constipation, diarrhea, and fever (Shogilev, Duus, Odom, & Shapiro, 2014). The symptoms observed in Jerome can also be associated with acute pancreatitis which is characterized by abdominal pain, fever, nausea, and vomiting. The pain can radiate to a patient’s back and depend on eating (Tenner, Baillie, DeWitt, & Vege, 2013). Gastritis is the inflammation of a stomach that can have the following symptoms: nausea, vomiting, abdominal pain, indigestion, and the loss of appetite. Gastric ulcer is a type of peptic ulcer is characterized by stomach pain, loss of appetite, nausea, vomiting, and bloating (Satoh et al., 2016). Cholecystitis also has symptoms related to the case: abdominal pain, tenderness of a patient’s abdomen, fever, nausea, and vomiting (Yamashita et al., 2013).

Final Diagnosis and Plan

The final diagnosis is appendicitis. The reason is that Jerome experiences the pain that does not radiate to any other organ, it does not depend on eating, and its location in the abdomen is associated with appendicitis (Kollár, McCartan, Bourke, Cross, & Dowdall, 2015). The assessment demonstrates that Jerome experiences the pain radiated to the right lower quadrant, and tenderness on palpation in the periumbilical area can be observed. The abdominal pain which starts as epigastric pain and then radiates to the right lower quadrant of a patient’s abdomen is typical of appendicitis. At this stage, vomiting, nausea, and fever are not observed. Furthermore, changes in the level of leukocytosis noted concerning the results of the complete blood count test and neutrophilia are typical signs of appendicitis. Immediate surgery should be planned to remove an appendix.

Assessment

While conducting the assessment of a patient’s abdomen concerning auscultation and palpation techniques, it is possible to determine normal and abnormal findings. The results of auscultation indicate that decreased peristalsis can be observed, and there are no bruits. The presence of sounds associated with peristalsis is normal, and it is important to pay attention to their frequency and intensity (Fritz & Weilitz, 2016). The absence of bruits is normal. During palpation, it is important to focus on examining tenderness and masses (Reuben, 2016). The examined abdomen is soft, and it is normal. The presence of tenderness on palpation in the right lower quadrant and rebound tenderness are abnormal and require further examination. The absence of pulsatile masses, as well as abdominal guarding, and the absence of observed hepatosplenomegaly are normal signs. In this case, abnormal signs are associated with appendicitis.

Conclusion

The conducted assessment of Jerome with the focus on the character of his abdominal pain and test results allows for speaking about appendicitis as the final diagnosis for this case. The conclusion is based on the analysis of symptoms, complaints, and findings of auscultation and palpation. For this case, immediate surgery can be discussed as an appropriate treatment option to remove the inflamed appendix.

References

Fritz, D., & Weilitz, P. B. (2016). Abdominal assessment. Home Healthcare Now, 34(3), 151-155.

Kollár, D., McCartan, D. P., Bourke, M., Cross, K. S., & Dowdall, J. (2015). Predicting acute appendicitis? A comparison of the Alvarado score, the appendicitis inflammatory response score and clinical assessment. World Journal of Surgery, 39(1), 104-109.

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Reuben, A. (2016). Examination of the abdomen. Clinical Liver Disease, 7(6), 143-150.

Satoh, K., Yoshino, J., Akamatsu, T., Itoh, T., Kato, M., Kamada, T.,… Murakami, K. (2016). Evidence-based clinical practice guidelines for peptic ulcer disease 2015. Journal of Gastroenterology, 51(3), 177-194.

Shogilev, D. J., Duus, N., Odom, S. R., & Shapiro, N. I. (2014). Diagnosing appendicitis: Evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine, 15(7), 1-12.

Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology guideline: Management of acute pancreatitis. The American Journal of Gastroenterology, 108(9), 1400-1415.

Yamashita, Y., Takada, T., Strasberg, S. M., Pitt, H. A., Gouma, D. J., Garden, O. J.,… Kim, S. W. (2013). TG13 surgical management of acute cholecystitis. Journal of Hepatobiliary-Pancreatic Sciences, 20(1), 89-96.

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