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· Ex-USMLE Forums Staff
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Appendicitis USMLE Guidelines

Now that ath.pantelis has given you a "real life" perspective let me give you a "USMLE" guideline for answering appendicitis questions.

Here's the deal;

If the case is an outright obvious clinical acute appendicitis like few hours or maximum few days pain that started centrally and moved to the right lower quadrant with tenderness and rebound and Rovsing's and Psoas signs positive with nausea and vomiting and mild fever and leukocytosis and normal urinalysis then you go for urgent surgery.

If you have any doubt about the diagnosis like with atypical presentation and absence of some of the signs of symptoms mentioned above then it's preferable to confirm the diagnosis before opening the patient's abdomen. Such confirmation can be either an ultrasound or CT scan. Ultrasound is specifically helpful in young females where you might want to exclude ovarian torsion or ectopic pregnancy and in cases where UTI is of high suspicion.

If the case is subacute like it has been there for several days or the patient has been having intermittent symptoms for quite a while or an abscess has already developed with a palpable mass in the right lower quadrant then generally the treatment is conservative with bowel rest, IV fluids, and antibiotics. The ultimate aim is to remove the appendix later electively.
 
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