Differential Diagnoses
The first differential diagnosis was urinary tract infection. I was able to identify tenderness in the suprapubic area. I associated this finding with burning micturition and checked for the signs of fever and chills. To check for acute right-sided pyelonephritis, I examined Jerome to find if there was tenderness at his right costovertebral angle. Urine microscopy did not validate the presence of bacteria, and I moved on to the next differential diagnosis. Jerome did not have a history of peptic ulcer disease, but I focused on his pains and the intensity of the latter. His pains were rather abrupt and could be located in the right lower quadrant of the patient’s abdomen. The last differential diagnosis was right-sided ureteric stone. Due to the severe nature of Jerome’s pains, I decided to test this diagnosis as well. Even though one of the typical characteristics of right-sided ureteric stones is the absence of fever, I continued the examination. Urinalysis did not show any signs of blood. Abdominal x-rays did not identify any stones in the abdominal area, which led me to the final diagnosis.
Final Diagnosis
The final diagnosis was based on three key aspects. First, Jerome had serious abdominal pain. Knowing that appendicitis is commonly associated with an aching pain in the abdomen because of either an inflamed or swollen appendix, it was easy to conclude that Jerome’s abdominal wall was irritated (Ehrman & Favot, 2017). When I found sharp pain in the right lower part of the patient’s abdomen, I was almost sure that Jerome had appendicitis. The fact that it was a severe abdominal pain significantly contributed to the final diagnosis because it was characterized as much duller than the pain that could be observed at that time when the symptoms had merely started. The second aspect was a mild fever observed in the patient.
Commonly, appendicitis can trigger a fever between 99.5F and 100.5F. Knowing that Jerome had chills and abdominal pains, it was easy to conclude that he had appendicitis. In this case, if his appendicitis busted, Jerome would be exposed to a fever greater than 101.5F and an increased heart rate (Shogilev, Duus, Odom, & Shapiro, 2014). Third, I paid special attention to Jerome’s digestive distress. Based on the fact that some of the symptoms included nausea and vomiting, it was almost apparent that Jerome had appendicitis. He felt like he could not eat and lost appetite. This led to constipation and obstruction of Jerome’s bowel. After connecting the dots, I concluded that Jerome had appendicitis and had to be treated as soon as possible.
Specific Palpation Findings
Several palpation areas helped me to make several important conclusions. First, I palpated the left lower quadrant of appendicitis and identified both conventional and rebound tenderness in the right lower quadrant. Another type of tenderness that was identified was its flank variation. Even though it could relate to renal pathology, I decided that it was a sign of appendicitis in the patient. These palpation findings supported the fact that Jerome complained about pain in both the hip and knee when he performed internal rotation of the right leg. The extension of the right hip also gave a positive sign of inflammation in the appendix. Combined, these findings led to the conclusion that Jerome had appendicitis.
References
Ehrman, R. R., & Favot, M. J. (2017). Can abdominal ultrasonography be used to accurately diagnose acute appendicitis? Annals of Emergency Medicine, 70(4), 583-584.
Shogilev, D. J., Duus, N., Odom, S. R., & Shapiro, N. I. (2014). Diagnosing appendicitis: Evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine, 15(7), 859.