What is the most probable diagnosis and further management?
Dr. Tpbhat Bhat
What is the most probable diagnosis and further management?
A 25 year female patient presents with history of abdominal pain of 4 days duration. Initially pain started as Vague central abdominal pain in early morning hours. Pain was preceded by loss of appetite. The patient was constipated for a few days. She felt nauseated and vomited once on the first day of pain. Later pain shifted to right iliac Fossa. Her pain is aggravated by moving and coughing.

Patient is married and has 2 children. Her menstrual cycles are regular having normal blood flow. Her last menstural period was 6 days back. There is No history of discharge from vagina. On examination patient looks pale with mild pyrexia. The tongue is furred and there is fetor oris. Her pulse rate is 90/min. Abdominal examination revealed tender mass of 16*9cm size in right iliac Fossa with overlying muscle guard and rigidity confined to right iliac Fossa.

There is No intrinsic movement for mass and all borders are well made out except the lateral border. The mass is intra abdominal and intraperitoneal. There is no extension of mass below inguinal region. The rest of abdomen is soft and non tender.There is No free fluid. The bowel sounds are normally heard. On digital rectal examination, patient complained of pain deep in pelvis and mass is palpable per rectum. On vaginal examination movement of cervix did not cause pain and other systems are normal.

Dr. g●●●●v b●●●●●●a and 2 other likes this1 share
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Dr. T●●●●t B●●t
Dr. T●●●●t B●●t Internal Medicine
DIAGNOSIS in this case is APPENDICULAR MASS. *Diagnostic points in favour of appendicular mass may include **History of Murphy' s triad of symptoms -Migratory pain,Vomiting /anorexia,and fever. *Short duration *Patient -Ill looking and febrile *Tender mass in right iliac Fossa. *The Tender mass is distinct ,dull to percussion and fixed to right iliac fossa (Unlike ovarian).......................................................... ... Read more
Dec 13, 2018Like
Dr. T●●●●t B●●t
Dr. T●●●●t B●●t Internal Medicine
DIAGNOSIS in this case is APPENDICULAR MASS. *Diagnostic points in favour of appendicular mass may include **History of Murphy' s triad of symptoms -Migratory pain,Vomiting /anorexia,and fever. *Short duration *Patient -Ill looking and febrile *Tender mass in right iliac Fossa. *The Tender mass is distinct ,dull to percussion and fixed to right iliac fossa (Unlike ovarian).......................................................... ... Read more
Dec 13, 2018Like
Dr. T●●●●t B●●t
Dr. T●●●●t B●●t Internal Medicine
INITIAL MANAGEMENT OF APPENDICULAR MASS INCLUDE : The classical treatment so called Ochsner sherrimen regimen Consist of *Bed rest (preferably hospitalised) *Fluid intake output chart *Mark out the limits of mass on abdominal wall. *Pulse,temperature and respiration chart. *Initiate antibiotic therapy. *Patient is given fluid diet only initially. *Contrast enhanced CT is done to rule out abscess inside. ***INDICATIONS TO STOP CONSERVATIVE TREATMENT AND PROCEED TO SURGERY INCLUDE *Clinical deterioration - Rising Pulse rate -Febrile *Failure of mass to resolve *Peritonitis......................................................... Read more
Dec 13, 2018Like