Appendicitis阑尾炎是时

A25-year-oldwomanpresentstoherphysicianwithan8-hourhistoryofabdominalpain.Itbeganasdullperiumbilicalpain脐周钝痛butisnowsharpandlocatedintherightlowerquadrant(RLQ)局限于右下腹.Shealsoreportsnausea,lossofappetite,andsubjectivefever.Shedenieschangesinurinationorbowelhabits,dysuria,orrecentsickcontacts.Herlastmenstrualperiod末次月经was3weeksago.

Vitalsignsareasfollows:heartrateof/min,respiratoryrateof16/min,temperatureof38.8°C(°F),SpO2of96%.

Onexam,theabdomenisexquisitelytenderthroughoutwithpositiveRovsing罗氏征阳性andreboundtenderness反跳痛.Psoasandobturatorsignsarepresent腰大肌试验和闭孔内肌试验阳性.

Relevantlaboratoryfndingsareasfollows:

WBCcount:18,/mm3

β-Humanchorionicgonadotropin(β-hCG):Negative

Urinalysis:Negativeforblood,WBCs,leukocyteesterase,andprotein

Whatisthemostlikelydiagnosis?

Appendicitis.阑尾炎

Itisimportanttonotethatappendicitispresentingwithclassicsignsandsymptomscanbediagnosedclinically.

Delayedappendectomyincreasesthelikelihoodofperforation穿孔.

Contrast-enhancedabdominalCT增强CThasgoodsensitivityandspecifcityandcanbeagoodtoolfordiagnosis.Figure2presentsanabdominalCTwithcontrastshowingappendicitis.Thearrowindicatesthelocationofthein?amedappendix.

Whatisthedi?erentialdiagnosisforthispatient?

?Femalereproductive:

ectopicpregnancy异位妊娠(veryunlikelywithnegativeβ-hCG)

pelvicin?ammatorydisease(PID)

ovariantorsion卵巢扭转

rupturedGraafanfollicle

?Gastrointestinal:

Crohndisease(caninitiallypresentwithoutchangesinbowelhabits)

pepticulcerdisease

Yersiniaenterocoliticainfection小肠结肠炎耶尔森氏菌感染

?Urinaryandrenal:

Urinarytractinfections(UTIs)usuallypresentwithfrequency,urgency,anddysuria,ac