Appendicular abscess differential diagnosis: Difference between revisions
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==Differential diagnosis== | ==Differential diagnosis== | ||
Appendicular abscess should be diagnosed early and treat promptly not only to reduce [[morbidity]] and [[mortality]], but it is also important to differentiate from other abdominal diseases presenting with [[Right lower quadrant abdominal pain resident survival guide|RLQ pain]] , [[fever]], [[nausea]] and [[vomiting]] such as [[psoas abscess]], [[cellulitis]], torsion of [[Testicular torsion|testis]] and [[Ovarian torsion|ovaries]], [[ectopic pregnancy]] etc as the un-drained abscess carries high risk of mortality <ref name="pmid25009411">{{cite journal |vauthors=Otowa Y, Sumi Y, Kanaji S, Kanemitsu K, Yamashita K, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Kakeji Y |title=Appendicitis with psoas abscess successfully treated by laparoscopic surgery |journal=World J. Gastroenterol. |volume=20 |issue=25 |pages=8317–9 |year=2014 |pmid=25009411 |pmc=4081711 |doi=10.3748/wjg.v20.i25.8317 |url=}}</ref><ref name="pmid28261018">{{cite journal |vauthors=Kim DH, Cheon JH |title=Pathogenesis of Inflammatory Bowel Disease and Recent Advances in Biologic Therapies |journal=Immune Netw |volume=17 |issue=1 |pages=25–40 |year=2017 |pmid=28261018 |pmc=5334120 |doi=10.4110/in.2017.17.1.25 |url=}}</ref><ref name="pmid27658552">{{cite journal |vauthors=van Hulsteijn LT, Mieog JS, Zwartbol MH, Merkus JW, van Nieuwkoop C |title=Appendicitis Presenting As Cellulitis of the Right Leg |journal=J Emerg Med |volume=52 |issue=1 |pages=e1–e3 |year=2017 |pmid=27658552 |doi=10.1016/j.jemermed.2016.07.008 |url=}}</ref><ref name="pmid28293278">{{cite journal |vauthors=Cirocchi R, Afshar S, Di Saverio S, Popivanov G, De Sol A, Gubbiotti F, Tugnoli G, Sartelli M, Catena F, Cavaliere D, Taboła R, Fingerhut A, Binda GA |title=A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine |journal=World J Emerg Surg |volume=12 |issue= |pages=14 |year=2017 |pmid=28293278 |pmc=5345194 |doi=10.1186/s13017-017-0120-y |url=}}</ref><ref name="Ramakrishnan">{{cite journal | author=Ramakrishnan K, Scheid DC | title=Diagnosis and management of acute pyelonephritis in adults | journal=Am Fam Physician | year=2005 | pages=933-42 | volume=71 | issue=5 | id=PMID 15768623 | url=http://www.aafp.org/afp/20050301/933.html}}</ref><ref name="pmid25285023">{{cite journal |vauthors=Smorgick N, Maymon R |title=Assessment of adnexal masses using ultrasound: a practical review |journal=Int J Womens Health |volume=6 |issue= |pages=857–63 |year=2014 |pmid=25285023 |pmc=4181738 |doi=10.2147/IJWH.S47075 |url=}}</ref> | Appendicular abscess should be diagnosed early and treat promptly not only to reduce [[morbidity]] and [[mortality]], but it is also important to differentiate from other abdominal diseases presenting with [[Right lower quadrant abdominal pain resident survival guide|RLQ pain]] , [[fever]], [[nausea]] and [[vomiting]] such as [[psoas abscess]], [[cellulitis]], torsion of [[Testicular torsion|testis]] and [[Ovarian torsion|ovaries]], [[ectopic pregnancy]] etc as the un-drained abscess carries high risk of mortality <ref name="pmid25009411">{{cite journal |vauthors=Otowa Y, Sumi Y, Kanaji S, Kanemitsu K, Yamashita K, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Kakeji Y |title=Appendicitis with psoas abscess successfully treated by laparoscopic surgery |journal=World J. Gastroenterol. |volume=20 |issue=25 |pages=8317–9 |year=2014 |pmid=25009411 |pmc=4081711 |doi=10.3748/wjg.v20.i25.8317 |url=}}</ref><ref name="pmid28261018">{{cite journal |vauthors=Kim DH, Cheon JH |title=Pathogenesis of Inflammatory Bowel Disease and Recent Advances in Biologic Therapies |journal=Immune Netw |volume=17 |issue=1 |pages=25–40 |year=2017 |pmid=28261018 |pmc=5334120 |doi=10.4110/in.2017.17.1.25 |url=}}</ref><ref name="pmid27658552">{{cite journal |vauthors=van Hulsteijn LT, Mieog JS, Zwartbol MH, Merkus JW, van Nieuwkoop C |title=Appendicitis Presenting As Cellulitis of the Right Leg |journal=J Emerg Med |volume=52 |issue=1 |pages=e1–e3 |year=2017 |pmid=27658552 |doi=10.1016/j.jemermed.2016.07.008 |url=}}</ref><ref name="pmid28293278">{{cite journal |vauthors=Cirocchi R, Afshar S, Di Saverio S, Popivanov G, De Sol A, Gubbiotti F, Tugnoli G, Sartelli M, Catena F, Cavaliere D, Taboła R, Fingerhut A, Binda GA |title=A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine |journal=World J Emerg Surg |volume=12 |issue= |pages=14 |year=2017 |pmid=28293278 |pmc=5345194 |doi=10.1186/s13017-017-0120-y |url=}}</ref><ref name="Ramakrishnan">{{cite journal | author=Ramakrishnan K, Scheid DC | title=Diagnosis and management of acute pyelonephritis in adults | journal=Am Fam Physician | year=2005 | pages=933-42 | volume=71 | issue=5 | id=PMID 15768623 | url=http://www.aafp.org/afp/20050301/933.html}}</ref><ref name="pmid25285023">{{cite journal |vauthors=Smorgick N, Maymon R |title=Assessment of adnexal masses using ultrasound: a practical review |journal=Int J Womens Health |volume=6 |issue= |pages=857–63 |year=2014 |pmid=25285023 |pmc=4181738 |doi=10.2147/IJWH.S47075 |url=}}</ref><ref name="pmid26554319">{{cite journal |vauthors=Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S |title=The Diagnosis and Treatment of Ectopic Pregnancy |journal=Dtsch Arztebl Int |volume=112 |issue=41 |pages=693–703; quiz 704–5 |year=2015 |pmid=26554319 |pmc=4643163 |doi=10.3238/arztebl.2015.0693 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;"|Diseases | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;"|Diseases | ||
Revision as of 13:56, 3 April 2017
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Appendicular abscess Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Appendicular abscess differential diagnosis On the Web |
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American Roentgen Ray Society Images of Appendicular abscess differential diagnosis |
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Risk calculators and risk factors for Appendicular abscess differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Appendicular abscess must be differentiated from other causes of abdominal pain such as acute gastroenteritis and luminal obstruction. Age group and gender of the patient must be considered in differentiating an appendicular abscess from other intra-abdominal abscesses with similar complaints.
Differential diagnosis
Appendicular abscess should be diagnosed early and treat promptly not only to reduce morbidity and mortality, but it is also important to differentiate from other abdominal diseases presenting with RLQ pain , fever, nausea and vomiting such as psoas abscess, cellulitis, torsion of testis and ovaries, ectopic pregnancy etc as the un-drained abscess carries high risk of mortality [1][2][3][4][5][6][7]
| Diseases | Clinical features | Diagnosis | Associated findings | |||||
|---|---|---|---|---|---|---|---|---|
| Symptoms | Signs | Laboratory fingdings | Radiological findings | |||||
| Fever | Abdominal pain | Nausea
vomiting |
Diarrhea | |||||
| Psoas abscess | + |
Dull RLQ pain radiating to hip and thigh |
+ | - |
Positive Psoas sign |
CT demostrates enhancing collection in the psoas muscle. |
| |
| Cellulitis of right thigh | + | - | - | - |
Involved site is red, hot, swollen, and tender[3] |
|
Severe infection is indicated by
| |
| Crohn's disease | + |
RLQ continuous localized pain |
+ |
Bloody |
Fullness or a discrete mass in the RLQ of the abdomen |
[ASCA]) are found in Crohn disease |
Transmural ulcerations are seen on colonoscopy |
|
| Gastroenteritis
(Bacterial and viral) |
+ |
Diffuse crampy intermittent abdominal pain |
+ |
Bloody or watery |
Rebound tenderness, rash |
|
No specific findings |
|
| Primary peritonitis | + |
Abrupt diffuse abdominal pain |
+ |
Bloody/watery |
Abdominal distension, rebound tenderness |
Peritoneal fluid shows >500/microliter count and >25% polymorphonuclear leukocytosis. |
|
|
| Pyelonephritis | + |
Flank pain radiating to inguinal region |
+ | - |
CVA tenderness |
Urine microscopy and culture confirm presence of bacteria. |
|
|
| Ovarian torsion | - |
Sudden sharp pain |
+ | - |
Unilateral, tender adnexal mass |
Ultrasonography shows ovarian cyst and decreased blood flow |
| |
| Testicular torsion | - |
Sudden sharp pain |
+ | - |
|
|
|
|
| Pelvic inflammatory disease | + |
Bilateral lower quadrant pain |
+ | - |
|
|
Transvaginal ultrasonographic scanning or magnetic resonance imaging (MRI) shows thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian abscess (TOA). |
Laparoscopy helps in confirmation of the diagnosis |
| Ruptured ectopic pregnancy | + |
Diffuse abdominal pain |
+ | - |
|
BHCG hormone level is high in serum and in urine |
Ultrasound reveals presence of mass in fallopian tubes. |
|
References
- ↑ Otowa Y, Sumi Y, Kanaji S, Kanemitsu K, Yamashita K, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Kakeji Y (2014). "Appendicitis with psoas abscess successfully treated by laparoscopic surgery". World J. Gastroenterol. 20 (25): 8317–9. doi:10.3748/wjg.v20.i25.8317. PMC 4081711. PMID 25009411.
- ↑ Kim DH, Cheon JH (2017). "Pathogenesis of Inflammatory Bowel Disease and Recent Advances in Biologic Therapies". Immune Netw. 17 (1): 25–40. doi:10.4110/in.2017.17.1.25. PMC 5334120. PMID 28261018.
- ↑ 3.0 3.1 3.2 van Hulsteijn LT, Mieog JS, Zwartbol MH, Merkus JW, van Nieuwkoop C (2017). "Appendicitis Presenting As Cellulitis of the Right Leg". J Emerg Med. 52 (1): e1–e3. doi:10.1016/j.jemermed.2016.07.008. PMID 27658552.
- ↑ Cirocchi R, Afshar S, Di Saverio S, Popivanov G, De Sol A, Gubbiotti F, Tugnoli G, Sartelli M, Catena F, Cavaliere D, Taboła R, Fingerhut A, Binda GA (2017). "A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine". World J Emerg Surg. 12: 14. doi:10.1186/s13017-017-0120-y. PMC 5345194. PMID 28293278.
- ↑ Ramakrishnan K, Scheid DC (2005). "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician. 71 (5): 933–42. PMID 15768623.
- ↑ Smorgick N, Maymon R (2014). "Assessment of adnexal masses using ultrasound: a practical review". Int J Womens Health. 6: 857–63. doi:10.2147/IJWH.S47075. PMC 4181738. PMID 25285023.
- ↑ Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S (2015). "The Diagnosis and Treatment of Ectopic Pregnancy". Dtsch Arztebl Int. 112 (41): 693–703, quiz 704–5. doi:10.3238/arztebl.2015.0693. PMC 4643163. PMID 26554319.