What's Your Diagnosis? Abdominal Pain in the ED

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department correct.

Case Presentation: Abdominal Pain: Update on Emergency Department Management of Appendicitis and Diverticulitis

A 24-year-old man presents to the ED complaining of 2 days of abdominal pain that has moved to his right lower quadrant…

The patient says he’s had a slight fever at home. His current vital signs are: temperature, 38.2ºC; heart rate, 108 beats/min; blood pressure, 122/70 mm Hg; and respiratory rate, 14 breaths/min.
On palpation, his abdomen is soft and not distended, with tenderness to palpation in the periumbilical area and right lower quadrant. Bowel sounds are present.
You order a urinalysis, complete blood cell (CBC) count, basic metabolic panel (BMP), liver function tests (LFTs), and lipase level, and administer IV morphine, IV crystalloid fluids, and antipyretics.
You have high suspicion for appendicitis and consider what type of imaging should be ordered. You wonder: do scoring systems really work? And if it is appendicitis, can you send this patient home on oral antibiotics?

Case Conclusion

After a shared decision-making conversation with the patient and the ED and surgical teams, the care team decided to take the nonoperative approach with antibiotics. The patient was later discharged from the hospital on an oral antibiotic course, with complete resolution of his symptoms.