Assessment and Differential Diagnostic Testing, Essay Example

Outline

Introduction

  • Appendicitis workup/ assessment

 

  • Differential diagnosis

Tests to be conducted

  • Ectopic Pregnancy

 

  • Intestinal Obstruction

 

  • Urinary Tract Infection

 

  • Pancreatitis

 

Conclusion

Introduction

Mrs. Jones 46, year old female presents at the emergency with lower left quadrant pain. Upon physical examination no abnormalities were detected in any organ system. However, a provisional diagnosis of appendicitis was made. A number of assessment procedures along with diagnostic testing must be conducted to confirm the diagnosis even with the history outlined. Assessment includes a full physical examination of the gastro intestinal system.

Appendicitis workup/ assessment

Inspection: – The abdomen is normal, but patient is anxious experiencing excruciating pain in the left quadrant region.

Palpation: – There is rebound tenderness in this left quadrant region.

Percussion: – Pain, guarding and rigidity.

Stomach: – No tenderness but patient tends to wretch on palpation

Oral cavity: – Pink and moist- no abnormalities

Intestines: No looseness of bowels

Pelvic and lower extremities: – The obturator sign is present with internal rotation of the thigh pain occurs in cases of pelvic appendicitis. Alternatively, the psoas sign is present when the extension of the right thigh creates pain in retroperitoneal or retrocecal appendicitis (Craig & Brenner, 2013).

Laboratory tests: – These may not show significant signs of the condition. However, a CBC could show elevated white blood cell count.

Studies have shown where while pain radiating towards McBurney’s point has been a reliable diagnosis it is not altogether true. One hundred patients were evaluated undergoing 3-dimensional (3-D) multidetector computed tomography (MDCT) scanning. It was discovered that in only 4% of patients the base of the appendix was located at the McBurney point; in 36%, it was within 3 cm of the point;  28%, 3-5 cm and, in 36% of patients, it was more than 5 cm from the McBurney point (Craig & Brenner, 2013).

Differential diagnosis

The differential diagnoses identified are:-

  • Ectopic Pregnancy
  • Intestinal Obstruction
  • Urinary Tract Infection
  • Pancreatitis

Tests to be conducted

Ectopic Pregnancy: – Transvaginal ultrasound detects pregnancy. A Serum beta positive test showing human chorionic gonadotropin level of 1,500 mIU per L (1,500 IU per mL) or higher indicates ectopic pregnancy, which rules out appendicitis.

Intestinal Obstruction: – Bloating and tenderness would be present upon abdominal palpation.

Also, herniation could be visible upon inspection. Diagnostic tests include CT scan; abdominal

X-Ray; barium enema and abdominal series of X-rays to examine stomach; esophagus and small

intestines. Changes in the size of these organs indicate abdominal obstruction. In appendicitis

there are no abnormalities.

 Urinary Tract Infection: – Inspection of the urinary tract gives an inflamed appearance and exudate may be present. Upon palpation there is tenderness in the lower pelvis and pain or discomfort upon urination. A urinalysis usually reveals cloudiness and odor not consistent with normal urine. Urine culture is followed whereby bacteria are isolated and sensitivity identified. These are the specific tests, which rule out appendicitis.

Pancreatitis: – Palpation reveals a swollen tender abdomen accompanied by nausea and

vomiting. Diagnostic tests include pancreatic function tests; glucose tolerance tests; ultrasound;

CT scan; endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound

(EUS) and biopsy. These test are not conducted when appendicitis is diagnosed, but they provide

solid guidelines for ruling out pancreatitis.

Conclusion

The foregoing tests provided validated the presence of appendicitis while ruling out ectopic pregnancy, which affects the reproductive system; intestinal obstruction even though a gastrointestinal dysfunction presents with abdominal herniation. Urinary tract infection bacteria shows up in the urine, a significant difference in appendicitis and in pancreatitis there is associating weight loss as well as elevated glucose levels (Primrose, 2001).

 References

Craig, S., & Brenner, B (2013). Appendicitis Clinical Presentation. Medscape. Retrieved on March 6th, 2013 from http://emedicine.medscape.com/article/773895-clinical

Primrose, A. (2001). The Differential Diagnosis of Appendicitis. Can Med Assoc J, 11(1): 23–26