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Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Direct abdominal tenderness is the most constant physical finding among pregnant patients with appendicitis. Only rarely is this finding absent (25,26). In the first trimester, tenderness is usually well localized in the right lower quadrant. With advancing gestation, there is still some thought that tenderness may be found in the right periumbilical area or right upper quadrant; however, in the study by Hodjati et al., this was not necessarily true. About 55% to 75% of patients have demonstrable rebound tenderness (21,25–28). One-half to two-thirds of patients have abdominal muscle rigidity (21,25–29). Rovsing’s sign is present approximately equally in pregnant as in nonpregnant patients with appendicitis. Psoas irritation is less frequently observed in pregnancy (30). Rectal examination is often overlooked in the pregnant patient with appendicitis, but one group has found that tenderness is usually present, especially in the first trimester (25). Fever and tachycardia are variably present and are not sensitive signs for appendicitis in pregnancy.
Answers
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Marfan’s syndrome is a connective tissue disorder affecting primarily musculo-skeletal, cardiovascular and ocular systems. Abnormally long limbs and increased flexibility of the joints is seen. Steinberg’s sign is positive when the thumb, when enclosed in the fist, protrudes beyond the medial border of the hand. Walker’s sign is positive when the little finger and thumb overlap while encircling the contralateral wrist. Gower’s sign is seen in Duchenne’s muscular dystrophy when the child uses his or her hands to climb up his or her legs while getting up. Rovsing’s sign is seen in appendicitis where palpation of the left iliac fossa reproduces pain in the right iliac fossa, presumably due to peritoneal irritation. Scarf sign is elicited in the newborn and assesses the tone of the muscles in the upper limbs. Murphy’s sign is seen in acute cholecystitis.
Surgery
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 20-year-old man presents to A&E with abdominal pain. The pain started in the periumbilical region, but is now felt in the right iliac fossa. On examination, there is right iliac fossa tenderness with guarding and rebound tenderness. He also has a positive Rovsing’s sign. A diagnosis of acute appendicitis is made. Apart from abdominal pain, give two symptoms of acute appendicitis. (2)Why is the pain first felt in the periumbilical region? (1)Why does it then migrate to the right iliac fossa? (1)What is Rovsing’s sign? (1)Give two differentials of appendicitis. (2)What is the definitive treatment of appendicitis? (1)Give two possible complications of appendicitis. (2)
Abdominal pain – a common presentation with unusual diagnosis: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Yeshaswini. P.S. Reddy, Sriviji Senthil Kumaran, Varun Vanka, Asra Rab, Viren Patel
During this hospitalisation, she remained hemodynamically stable but endorsed significant distress due to the abdominal pain. Severe tenderness in the right lower quadrant to mild palpation with guarding, positive McBurney’s point tenderness, and positive rovsing’s sign were observed; psoas sign and obturator sign however were negative. Mildly decreased bowel sounds and absence of organomegaly were noted. Given the presentation, our differential diagnosis included acute appendicitis, acute ovarian torsion, Mckel’s diverticulum, acute ileitis, PID, ovarian cyst, renal calculus, endometritis, ectopic pregnancy, or tubo-ovarian abscess.