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Differentials
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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
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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
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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
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Acute Cholecystitis
• Secondary to gallstones in 95% of cases• Biliary colic, RUQ tenderness, guarding• Murphy’s sign• Mild to moderate leukocytosis
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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
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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
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Complicated Diverticulitis
• With abscess, obstruction, diffuse peritonitis, free perforation, fistula formation
• More often localized than generalized peritonitis• Prior history of diverticulosis/diverticulitis
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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
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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