Tuesday, October 4, 2016

Acute Appendicitis

EM Didactic - October 3, 2016 - By Lakshay Chanana
"RLQ pain is quite a common presentation in the ED. We always think and rule out appendicitis first. So this week, lets go through a few questions that popped into my mind while evaluating a RLQ/RIF pain. To begin with, I was always taught that appendix is a vestigial organ but recent literature on biofilms suggests that appendix may act as a storehouse for commensal microorganisms that defend us against pathogens...
Take Home:
  • Pain Relief always comes first.
  • A normal white cell count, a negative USG or even a negative CT cannot rule out appendicitis in a patient with concerning story and physical exam. Therefore, whenever sending them home, discuss reg flags and document that in the patient's chart.
  • Pregnancy with RLQ pain, start with USG and then MRI scan if needed. A shielded CT should only be your last option here.
  • Have a low threshold to obtain imaging in every female with RLQ pain because appendicitis is "not always" a clinical diagnosis."