Differentials

Acute appendicitis

• Epigastric/periumbilical pain(RUQ)• Pain, anorexia, nausea and vomiting, fever (pain or

vomiting will come first before anorexia)• Tenderness of Mc Burney’s point with muscle

guarding and rebound tenderness• (+) Rovsing’s/ Psoas / Obturator sign• Mild leukocytosis

Appendiceal Rupture

• <5 and >65 y/o – highest rate of rupture• Suspect if fever (39C) or WBC >18,000/mm3• Generalized peritonitis if the walling of process

Acute diverticulitis

• Occur more often after the age of 40• LLQ pain and tenderness• Leukocytosis• CT scan: Contrast angiography– Pericolic stranding– Thickened fat– Extravasation of the dye if with contrast

Acute Cholecystitis

• Secondary to gallstones in 95% of cases• Biliary colic, RUQ tenderness, guarding• Murphy’s sign• Mild to moderate leukocytosis

Acute Pancreatitis

• 80-90% caused by gallstones or alcholism• Severe epigastric pain radiating to the back • Elevated serum anylase• Cullen’s sign, Grey Turner sign• Massive third spacing

Thyphoid Ulcer perforation

• headache, fever, and malaise for 2 weeks• followed by a dull pain suddenly getting worse and

spreading, moderate tenderness, and guarding • 3rd or 4th week of typhoid fever• Severe abdominal pain, tenderness, rigidity• Can have association with intestinal obstruction and

protracted fever

Complicated Diverticulitis

• With abscess, obstruction, diffuse peritonitis, free perforation, fistula formation

• More often localized than generalized peritonitis• Prior history of diverticulosis/diverticulitis

Volvulus

• Air filled colon twists about its mesentery • Sudden onset of acute pain in the left hemiabdomen

with abdominal distention, obstipation• Fever and leukocytosis• Bowel obstruction, may progress to strangulation,

gangrene and perforation

Mesenteric Ischemia

• Embolic source usually coming from the heart• Should have a high index of suspicion • Severe abdominal pain disproportionate to

abdominal findings– Bowel infarction: distention, peritonitis, bloody stools

• Vomiting and diarrhea