Doctor, I am getting pain in the right lower abdomen since 3 days, This is the third time in 6 months.
I have to mainly rule out Appendicitis, amoebic colitis and ureteric colic. Also, Ileo-caecal tuberculosis since it is chronic.
1. Is the pain colicky & intermittent, or continuous? “Doctor, it is continuous.” 2. Is it associated with fever? Vomiting? “Yes I had fever.” (Triad of pain, fever & vomiting in appendicitis). 3. Was there dysuria or dark colored urine? “No” (Rules
Out ureteric colic)
1. Did you have loose motions with mucus? “No” (For Amoebiasis) 2. How is the apetite? “Less” (In amoebiasis, apetite is good, while in appendicitis, it is reduced)
Palpate the abdomen.
This patient has localized tenderness around the MacBurney’s point. There is no renal angle tenderness.
Tenderness almost rule out ureteric colic. It is either appendicitis or amoebic colitis.
Mild tenderness in the Epigastrium is not uncommon in appendicitis,
If tenderness is also present on the left side, it is more likely to be amoebic colitis. Treat with Metronidazole or Tinidazole first.
And then reassess,
• If there is fullness or lump in the right iliac fossa, or if there is H/O low grade fever, weight loss, pulmonary Tuberculosis, then think of Ileocaecal tuberculosis.
• In a female patient, Gynaecological examination is must before coming to any conclusion. Take detailed menstrual history, rule out dysmenorrhoea, P.I.D., Right T-O mass, and if in early pregnancy, ruptured ectopic. Action:
1. If the clinical picture is mixed, give a course of Tinidazole or Metronidazole. If tenderness persists, it is chronic appendicitis. 2. Definitive diagnosis is mainly clinical. Supportive evidence = Barium meal & Ultrasonography. Also ask for Hb, WBC, Stools, Urine, KUB, USG, Barium meal.
Once chronic appendic appendicitis is diagnosed, refer to a surgeon for operation, You may give a trial of a full course of Ciplox –TZ 1 BD for 5 days before finally advising surgery,
