Right Lower Quadrant Pain

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Right Lower Quadrant Pain SYB January 24,
2008 Julianne Lauring
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43 yo male presents to the ED with RLQ pain
Inflammation
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Inflamed Appendix
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Fecalith
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Appendicitis

• 7 of the US population
• Incidence of 1.1/1000 people per year
• Mortality of 0.2-0.8 due to complications, not
  surgical intervention
• Mortality increases to 20 in patients over 70
• Perforation is highest among patients younger
  than 18 years and over 50 years
• HX
• Only 50 of patients present with classic history
  of anorexia and periumbilical pain followed by
  nausea, RLQ pain, and vomiting
• Migration is the most discriminating factor
• Vomiting before pain suggests obstruction
• Physical
• RLQ tenderness is present in 96 of patients but
  this is nonspecific
• Minority of patients have Rovsing sign (RLQ pain
  with palpation of LLQ), obturator sign (RLQ pain
  with internal rotation of flexed hip), and the
  psoas sign (RLQ pain with hyperextension of the
  right hip)
• Cause Obstruction of lumen
• Fecaliths
• Lymphoid hyperplasia
• Other less common causes include parasites,
  foreign materials, TB, and tumor

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Appendicitis Imaging

• CT Imaging modality of choice
• US Best for pregnant women and children because
  of lack of radiation exposure
• Abdominal Radiography Consensus is that it is
  insensitive, nonspecific, and not cost-effective
• Barium Enema No role in era of US and CT due to
  high incidence of nondiagnostic results,
  radiation exposure, insufficient sensitivity, and
  invasiveness
• Radionuclide Scanning No role due to 5 hour
  acquisition time and lack of availability despite
  high sensitivity (98)
• MRI single study of 51 patients shows high
  sensitivity and specificity but expense and
  acquisition time make CT a better choice

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References

• Emedicine -
• www.emedicine.com/emerg/TOPIC41.HTM
• Appendicitis, Acute by Sandy Craig, MD