PATHO WEEK 5 DISCUSSION.
Ms. F, 48 years old, has been admitted to the hospital with severe abdominal pain. Earlier that
day she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of
her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly
improved, and the pain seemed to subside somewhat. Later that night, severe, steady abdominal
pain developed, with vomiting. A friend took her to the hospital, where examination
demonstrated lower right quadrant tenderness and mild abdominal rigidity. Fever and
leukocytosis indicated infection. A diagnosis of acute appendicitis, with possible perforation, was
indicated, with immediate surgery.
WHY IS THE SEQUENCE OF PAIN (LOCATION AND TYPE OF PAIN)
SIGNIFICANT IN THE DIAGNOSIS OF ACUTE APPENDICITIS?
DESCRIBE THE RATIONAL FOR EACH TYPE OF PAIN. DOES THIS
SEQUENCE CONFIRM THE DIAGNOSIS?
The patient’s sequence of pain is within the signs and symptoms of many
abdominal disorders. Appendicitis is known to manifest without acute symptoms
initially, Mrs. F abdominal pain combined with nausea and vomiting could be less
than anything of importance. Generally, the pain starts as a colicky periumbilical
pain which increases in severity as the inflamed appendix is distended. Then the
pain radiates to the lower right quadrant of the abdomen where deep localized
tenderness is present upon palpation. Pain in the lower right quadrant is related
to the inflamed stretched tissues of the appendix. After appendix ruptures pain at
this point decreases as the appendix spills its contents into the peritoneal cavity
