Here's another one:
An older Hmong guy complains about abdominal pain. He presents with rebound tenderness. Does not feel like eating or drinking. In the prone position, leg raise is painful. Jumping up and down elevate his pain to a 10 of out 10. Everything points towards appendicitis.. .except, the pain is localized on the left side and NOT at Mcburney's point. What can it be?
Not all appendicitis present with RLQ pain.
Ddx: appendicitis, perforated appendicitis, perforated diverticulitis, diverticulitis, u/c
Mgmt: npo, Iv fluids, morphine, ct scan, prophylaxis abx zosyn for intra-abdominal coverage. Consult surgery for evaluation.
Labs: CBC w diff, chem 7, LFT, amylase, lipase, lactic acid,