appendix & PID

[roysap]

Appendicitis often known as 'disease with a thousand faces'. When ruptured/ perforated, it developed peritonitis. The most likely differential diagnosis when the signs & symptoms appear in young female adults is pelveoperitonitis or PID. Are there any practical ways to differentiate in sure about those two since the impact to the patient is crutial when applying treatment (PID usually non-operative) ? Douglas punction sometimes not helpful since the pus already had matured (forming gel-like fibrin-to-be).
Intravaginal USG?

[draft]

CT scan in appendicitis shows inflamation around the appendix. Also, PID is due usually to either gonorhhea or chlamydia - so you can test you patient for these. Also ever hear of "chandelier sign" in pid - extreme motion tenderness to motion of the cervix/uterus manipulation typically causes patient to "hit the ceiling" Also in HPI appendicitis pain usually starts around umbilicus, and it migrates to McBurney's point... I'm sure there are many other ways to distinguish these 2...

[usmlethinking]

How about appendicitis in pregnancy? Oh boy it can really fool you.

[vadimk]

Originally Posted by usmlethinking

How about appendicitis in pregnancy? Oh boy it can really fool you.

Towards the end of pregnancy the Mc Burneys pt is displaced superiorly.

[vikram25]

In emergency setup,i dont think you can really wait for all those tests, it has to be aquick decision.
History given by the patient can be of help. History of discharge per vaginum,
fever for 3-4 days and ultrasonography may be of help.
CT abdomen and pelvis can be confirmatory.
mcqsurgery.com

[AUCMD2006]

cold steel cures, in an emergency get your history in the elevator to the OR ..hehe

treat the PID medically and do a exploratory lap...a few 1 inch scars are better than the alternative but yes cervical wall motion tenderness is useful. it could also be a ruptured ovarian cyst or ovarian torsion all of which you will see with the scope and if it is torsion and you get there early enough you can save the ovary. odd one was a bowel perf secondary to chicken bone with the requisite bonectomy

[Monsoonrain]

Originally Posted by usmlethinking

How about appendicitis in pregnancy? Oh boy it can really fool you.

I think we can rely on the Leukocytosis with left shift in that case.

[AUCMD2006]

Originally Posted by Monsoonrain

I think we can rely on the Leukocytosis with left shift in that case.

the last trimester pregant pts have leukocytosis with elevated neutrophils.

In this scene, can P.R/D.R.E be any useful?

[student-2]

Appendicitis usually has a history of nausea and loss of appetite. PID doesn't have rebound and guarding like appendicitis.
I think that besides for the presenting complaint it is usualy easy to differ the two