☆选自FirstAid
CasesfortheUSMLESTEP1
case3A25-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,