STATION 15 Name: Miss Natasha Sharma Age: Job: 4 19 years old Studying engineering at university PC: You have been feelin; 8 generally unwell since yesterday morning while you were at your lectures in university You developed cent ty, tral abdominal pain after you had your lunch (a ham and cheese sandwich) yesterday and th, pain has gradually worsened. When you went to bed in the evening you noticed that you felt hot and sweaty by thought it was because the weather was rather stuffy. You only started to get rather concerned when you awoke the not amoning fecling even worse, having had very little sleep and you were completely off your breakfast. You did Rot attend university today and had a bout of vomit a were concerned that you were really rather ill. You tried to get an appointment at your GP but none of the doctors were available and so you decided to come to hospital. yesterday. Apart from not yet opening your bowels today you hhave not noticed any change in bowel habits recently, You den been in contact with anyone tha 'y any preceding coryzal symptoms and have not ‘oms. You are not sure if ‘so can't igh you are on the pill you aren't part + 80 if you were pregnant it would be 2 you either. You do not have any vaginal discharge or any "t totally surprise bleeding that you have noticed on your knickers. oun and you think your symptoms are related i westernised. You ate out the night before last at a new Thai restaurant in the t you don’t usually eat spicy foods and your diet is really quiteCommunication kills: General Medical and Surgical Historie past Medical History: Asthma Drug History salbutamol inh 2 puffs pm Microgynon 30 (oral contraceptive pill) Social History: You live in University Halls and your mother is on her a oo about being in hospitals on your own, let Way to the hospital to come see you as you are worried You smoke 5 cigarettes a day and drink occasionally. Ideas/Concerns/Expectations: You are hoping it was just something you ate. You aii blood. You really don’t like the idea are very scared of needles so you do not want anyone to take of having an operation and if the doctor suggests this you ask if there is am chance you can have antibiotics to settle the symptoms dovn instead, : 7 Diagnosi Appendicitis Differentials: Ectopic pregnancy, ovarian torsion, ovarian cyst, gastroenteritis Management: Full clinical examination including per rectal examination. Routine blood tests: FBC, U&E, LFTs, CRP, BHCG, amylase, blood cultures, clotting and group and save. Urine dipstick (will show septic pyuria) including B-hCG. Admit patient — nil by mouth, IV fluids, analgesia Imaging: Arrange an urgent abdominal and transvaginal ultrasound to rule out gynaecological pathology. If the ultrasound does not visualise the appendix and shows no gynaecological pathology, the vatient will still Tequire a diagnostic laparoscopy +/- laparoscopic or open appendicectomy. In some hospitals an out-of-hours ultrasound scan may not be possible to request and occasionally these patients may have a CT Abdomen and Pelvis performed (although not if pregnancy is a possibility and the patient is of childbearing age). If the patient is clinically septic with raised inflammatory markers and there is a strong clinical suspicion of appendicitis then it is prudent to proceed to appendicectomy rather than to wait for imaging to be performed. A suspicion of a perforated appendix may be confirmed by an erect chest X-ray and visualisation of free air under the diaphragm, although a normal erect film will not exclude this diagnosis.