Editing Appendicitis (section)

== '''Differential diagnosis:''' ==

* Women:
** Ovarian torsion -      simultaneous onset of pain and vomiting, severe pain, non-migratory.      Fever and leucocytosis would be a late sign, associated with necrosis.
** Ovarian cyst rupture - free      fluid, midcycle sudden onset pain, often during sexual intercourse,      vomiting less common
*** Mittelschmerz: almost       precisely midcycle. Typically mild and unilateral pain, which lasts for       a few hours to a few days.
*** Corpus luteum cyst: at time       of menstruation
*** Cysts may not be seen on       ultrasound after rupture!
** Tubo-ovarian abscess/PID
*** Less likely to have       migratory pain
*** Less association with       vomiting
*** Often bilateral
*** Vaginal discharge
*** Cervical motion tenderness       may also be seen in appendicitis
** Ruptured ectopic - pain      sudden, palpable mass, a/w anaemia and shock
** UTI
** Endometriosis - chronic deep      pelvic pain and dyspareunia which typically occurs with menstruation or      ovulation.
** Ovarian hyperstimulation      syndrome
* Crohn's - look for a history     of previous attacks, palpable mass, thin patient. Suspect in ongoing     post-op pain with a histologically normal appendix.
* Pyelonephritis - expect     earlier and higher fever, dysuria/frequency, softer abdomen
** Perinephric abscess
** Nephrolithiasis
* Mesenteric adenitis -     commonly seen in children after an acute viral illness. Shouldn't have     much systemic features, not much tenderness/guarding, and not much     vomiting. May see evidence of viral infection on blood tests.
** Also discussed under      'mesenteric diseases'
* Gastroenteritis - this is     actually somewhat rare - consider if nausea/vomiting/diarrhoea     predominate, there are sick contacts, and/or there is minimal tenderness
** Most commonly Yersinia,      Salmonella or Campylobacter
** Commonly with yersiniosis -      will see a normal appendix but surrounding inflammation and      lymphadenopathy
* Intussusception
* Meckel diverticulitis
* Testicular torsion
* Diabetic ketoacidosis
* Right-sided diverticulitis
** Past history diverticulitis,      longer onset to presentation (2 days), lower WCC, higher CRP, less n/v      and anorexia
* Colon cancer
* Typhlitis (right-sided     colitis in neutropaenic patient)