Sunday, February 19, 2006
Does diagnosis acute appenditicis affect by decreased WBC count?
A 49 y/o male patient came to ER due to severe epigastric pain shift to RLQ pain. WBC 19400 seg 92. We consulted GS and said appendicitis is not likely at present moment due to no rebound pain and suggest followup WBC +DC 6hrs later. Followup WBC+DC showed 13500 Seg 67 CRP 3.9 and patient felt better and felt some hungry. What will you do? Let him try feeding and discharge him or tell him appendicitis is not likely due to WBC count decreased?
I check the patient who looks rather fat and obese abdomen. PE showed tenderness over Mcburny's point on deep palpation but marked rebound pain due to obesity. Bedside echo didn't showed any target sign but there is local tenderness during ultrasound examination. Abd CT showed enlarged appendix with wall thickening and perifocal fatty stranding(illustrated above). Operation showed engorged appendix with no perforation.
Discussion:
1. Acute appendicitis is diagnosed by clinically but not by laboratory data.
2. Followup WBC count if decreased does not mean decreased possibility of appendicits.
3. Don't rely too much on lab data or imaging, just rely on your basic physical examination.
# posted by ER Palm @ 4:51 PM 
Comments:
<< Home
What a great blog, you should visit my site also.
Woodland Hills Dentist - One of the best Woodland Hills Dentist there are. If you want pearly white teeth, click here to visit your Woodland Hills Dentist at http://www.woodlandhillsdentist.org
Post a Comment
Woodland Hills Dentist - One of the best Woodland Hills Dentist there are. If you want pearly white teeth, click here to visit your Woodland Hills Dentist at http://www.woodlandhillsdentist.org
# posted by 
: 3:10 AM
: 3:10 AM << Home
