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RLQ Abdominal Ultrasound

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1. RLQ Abdominal Ultrasound

RLQ Abdominal Ultrasound RLQ Abdominal Ultrasound Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 RLQ Abdominal Ultrasound RLQ (...) Abdominal Ultrasound Aka: RLQ Abdominal Ultrasound , Ultrasound in Appendicitis , Appendix Ultrasound II. Indications Suspected III. Precautions Consider in the emergency department Appendix Ultrasound can be used to diagnose , but not exclude Negative may require additional imaging (e.g. , MRI Appendix) Positive , diagnostic for Spares additional imaging (and radiation exposure) prior to appendectomy Perform at centers where ultrasonographer and radiologist are highly skilled at evaluation of appendix

2018 FP Notebook

2. RLQ Abdominal Ultrasound

RLQ Abdominal Ultrasound RLQ Abdominal Ultrasound Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 RLQ Abdominal Ultrasound RLQ (...) Abdominal Ultrasound Aka: RLQ Abdominal Ultrasound , Ultrasound in Appendicitis , Appendix Ultrasound II. Indications Suspected III. Precautions Consider in the emergency department Appendix Ultrasound can be used to diagnose , but not exclude Negative may require additional imaging (e.g. , MRI Appendix) Positive , diagnostic for Spares additional imaging (and radiation exposure) prior to appendectomy Perform at centers where ultrasonographer and radiologist are highly skilled at evaluation of appendix

2015 FP Notebook

3. Diagnostic accuracy of laboratory and ultrasound findings in patients with a non-visualized appendix. (PubMed)

] were diagnosed with appendicitis. Among patients with a non-visualized appendix, the likelihood of appendicitis was significantly greater if: inflammatory changes in the RLQ (OR 18.0, 95% CI 4.5-72.1), CRP >0.5 mg/dL (OR 2.64, 95% CI 1.0-6.8), or WBC > 10 (OR 4.36, 95% CI 1.66-11.58). Duration of abdominal pain >3 days was significantly less likely associated with appendicitis in this model (OR 0.34, 95% CI 0.003-0.395). Combined, the absence inflammatory changes, CRP < 0.5 mg/dL, WBC < 10 (...) , and pain, ≤3 days had a NPV of 94.0%. Conclusion When the appendix is not visualized on US, predictors for appendicitis include the presence of inflammatory changes in the RLQ, an elevated WBC/CRP and abdominal pain <3 days.Copyright © 2018 Elsevier Inc. All rights reserved.

2018 American Journal of Emergency Medicine

4. Predicting need for additional CT scan in children with a non-diagnostic ultrasound for appendicitis in the emergency department. (PubMed)

Predicting need for additional CT scan in children with a non-diagnostic ultrasound for appendicitis in the emergency department. This study aimed to determine which children with suspected appendicitis should be considered for a computerized tomography (CT) scan after a non-diagnostic ultrasound (US) in the Emergency Department (ED).We retrospectively reviewed patients 0-18year old, who presented to the ED with complaints of abdominal pain, during 2011-2015 and while in the hospital had both (...) vomiting or had right lower abdominal quadrant (RLQ) tenderness, peritoneal signs or White Blood Cell (WBC) count >10,000 in mm3 were more likely to have appendicitis on CT. RLQ tenderness (Odds Ratio: 2.84, 95%CI: 1.07-7.53), peritoneal signs (Odds Ratio: 11.37, 95%CI: 5.08-25.47) and WBC count >10,000 in mm3 (Odds Ratio: 21.88, 95%CI: 7.95-60.21) remained significant after multivariate analysis. Considering CT with 2 or 3 of these predictors would have resulted in sensitivity of 94%, specificity

2017 American Journal of Emergency Medicine

5. Diagnostic Accuracy of History, Physical Exam, Laboratory Tests and Point-of-Care-Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-Analysis. (PubMed)

department ultrasound (RUS).We searched PubMed, EMBASE, and SCOPUS up to October 2016 for studies on ED pediatric patients with abdominal pain. Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality and applicability of included studies. Positive and negative likelihood ratios (LR+ and LR-) for diagnostic modalities were calculated and when appropriate data was pooled using Meta-DiSc. Based on the available literature on the test characteristics of different (...) AA.Presence of AA is more likely in patients with undifferentiated abdominal pain migrating to the RLQ or when cough/hop pain is present in the physical examination. Once AA is suspected, no single history, physical examination, laboratory finding, or score attained on PAS can eliminate the need for imaging studies. Operating characteristics of ED-POCUS are similar to those reported for RUS in literature for diagnosis of AA. In ED patients suspected of AA, a positive ED-POCUS is diagnostic and obviates

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2017 Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

6. Intra-abdominal thrombolysis for septated SBP: a case. #FOAMed, #FOAMcc

Intra-abdominal thrombolysis for septated SBP: a case. #FOAMed, #FOAMcc Intra-abdominal thrombolysis for septated SBP: a case. #FOAMed, #FOAMcc | thinking critical care Menu So we had an interesting case this week of an alcoholic cirrhotic fellow in his 60’s who was admitted with SBP, septic and in respiratory failure. A pigtail had been inserted (RLQ) a few days ago successfully draining 3 litres of cloudy ascites which grew morganella and e.coli. Obviously he was treated with antibiotics (...) cloudy cc’s and the new one, 1,000 cc’s. We repeated the TPA for two more doses but little more came out. No bleeding, and he was on prophylactic anticoagulation. Just thought I’d put the case out there to add to the intra-abdominal thrombolysis data, which is substantially less than the pleural, and, as usual, to show how routine use of bedside ultrasound reveals things you’d either never otherwise see (loculations on CT??? Naaaah.), be guessing about, or have to wait and move your patient to CT

2016 Thinking critical care blog

7. Left Lower Quadrant Abdominal Pain

Left Lower Quadrant Abdominal Pain Left Lower Quadrant Abdominal Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Left Lower (...) Quadrant Abdominal Pain Left Lower Quadrant Abdominal Pain Aka: Left Lower Quadrant Abdominal Pain , LLQ Abdominal Pain , LLQ Pain From Related Chapters II. Causes: Gastrointestinal Infectious colitis III. Causes: Vascular Leaking aneurysm IV. Causes: Genitourinary See or torsion ( ) Renal pain Seminal vesiculitis V. Causes: Miscellaneous Psoas abscess Abdominal wall hematoma VI. Evaluation suspected (e.g. fever, history, RLQ tenderness, rectal bleeding) Empiric treatment for Consider with oral and IV

2018 FP Notebook

8. Right Lower Quadrant Abdominal Pain

Right Lower Quadrant Abdominal Pain Right Lower Quadrant Abdominal Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Right Lower (...) Quadrant Abdominal Pain Right Lower Quadrant Abdominal Pain Aka: Right Lower Quadrant Abdominal Pain , RLQ Abdominal Pain , RLQ Pain From Related Chapters II. Causes: Gastrointestinal (pain over ) III. Causes: Genitourinary or torsion ( ) Renal pain Seminal vesiculitis IV. Causes: Miscellaneous Leaking Abdominal wall hematoma Psoas abscess V. Evaluation Classic or red flags for peritonitis with IV contrast Findings suggest alternative diagnosis Evaluate for genitourinary and miscellaneous causes

2018 FP Notebook

9. Intra-abdominal thrombolysis for septated SBP: a case. #FOAMed, #FOAMcc

Intra-abdominal thrombolysis for septated SBP: a case. #FOAMed, #FOAMcc Intra-abdominal thrombolysis for septated SBP: a case. #FOAMed, #FOAMcc | thinking critical care Menu So we had an interesting case this week of an alcoholic cirrhotic fellow in his 60’s who was admitted with SBP, septic and in respiratory failure. A pigtail had been inserted (RLQ) a few days ago successfully draining 3 litres of cloudy ascites which grew morganella and e.coli. Obviously he was treated with antibiotics (...) cloudy cc’s and the new one, 1,000 cc’s. We repeated the TPA for two more doses but little more came out. No bleeding, and he was on prophylactic anticoagulation. Just thought I’d put the case out there to add to the intra-abdominal thrombolysis data, which is substantially less than the pleural, and, as usual, to show how routine use of bedside ultrasound reveals things you’d either never otherwise see (loculations on CT??? Naaaah.), be guessing about, or have to wait and move your patient to CT

2016 Thinking critical care blog

10. Accuracy of Magnetic Resonance Imaging and Ultrasound for Appendicitis in Diagnostic and Nondiagnostic Studies. (PubMed)

Accuracy of Magnetic Resonance Imaging and Ultrasound for Appendicitis in Diagnostic and Nondiagnostic Studies. Suggestive radiographic studies with nonvisualization of the appendix can present a challenge to clinicians in the evaluation of pediatric abdominal pain. The primary objective of this study was to quantify the accuracy of magnetic resonance imaging (MRI) and of ultrasound (US) in the setting of nonvisualization of the appendix. Secondary objectives reported include sensitivity of MRI (...) = 18.2% to 64.5%) for US. Appendicitis was ultimately diagnosed in 8.6% of patients with an otherwise negative right lower quadrant (RLQ) US that failed to directly identify the appendix. There was a moderate correlation between US and MRI (ρ = 0.573, p = 0.0001) when all studies were considered.Magnetic resonance imaging without secondary signs of appendicitis is effective in excluding appendicitis regardless of whether the appendix is directly visualized, while otherwise negative RLQ US that fail

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2016 Academic Emergency Medicine

11. Right Lower Quadrant Abdominal Pain

Right Lower Quadrant Abdominal Pain Right Lower Quadrant Abdominal Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Right Lower (...) Quadrant Abdominal Pain Right Lower Quadrant Abdominal Pain Aka: Right Lower Quadrant Abdominal Pain , RLQ Abdominal Pain , RLQ Pain From Related Chapters II. Causes: Gastrointestinal (pain over ) III. Causes: Genitourinary or torsion ( ) Renal pain Seminal vesiculitis IV. Causes: Miscellaneous Leaking Abdominal wall hematoma Psoas abscess V. Evaluation Classic or red flags for peritonitis with IV contrast Findings suggest alternative diagnosis Evaluate for genitourinary and miscellaneous causes

2015 FP Notebook

12. Left Lower Quadrant Abdominal Pain

Left Lower Quadrant Abdominal Pain Left Lower Quadrant Abdominal Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Left Lower (...) Quadrant Abdominal Pain Left Lower Quadrant Abdominal Pain Aka: Left Lower Quadrant Abdominal Pain , LLQ Abdominal Pain , LLQ Pain From Related Chapters II. Causes: Gastrointestinal Infectious colitis III. Causes: Vascular Leaking aneurysm IV. Causes: Genitourinary See or torsion ( ) Renal pain Seminal vesiculitis V. Causes: Miscellaneous Psoas abscess Abdominal wall hematoma VI. Evaluation suspected (e.g. fever, history, RLQ tenderness, rectal bleeding) Empiric treatment for Consider with oral and IV

2015 FP Notebook

13. Abdominal pain

of abdominal pain. (Buscopan) is used to treat cramping abdominal pain with some success. Surgical management for causes of abdominal pain includes but is not limited to , , and exploratory . Emergencies [ ] Below is a brief overview of abdominal pain emergencies. Condition Presentation Diagnosis Management Abdominal pain, nausea, vomiting, fever Periumbilical pain, migrates to RLQ Clinical (history & physical exam) Abdominal CT Patient made NPO (nothing by mouth) IV fluids as needed General surgery (...) consultation, possible Antibiotics Pain control Abdominal pain (RUQ, radiates epigastric), nausea, vomiting, fever, Clinical (history & physical exam) Imaging (RUQ ultrasound) Labs ( , , ) Patient made NPO (nothing by mouth) IV fluids as needed General surgery consultation, possible Antibiotics Pain, nausea control Abdominal pain (sharp epigastric, shooting to back), nausea, vomiting Clinical (history & physical exam) Labs (elevated ) Imaging (abdominal CT, ultrasound) Patient made NPO (nothing by mouth

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2012 Wikipedia

14. Appendicitis

110/60, HR 85, RR 12, Sat 98% on room air, T 36.5. Your colleague believes that the patient has appendicitis without peritonitis on exam (RLQ pain on palpation, but no guarding or rebound tenderness). Your colleague had already consulted the general surgeon on call who agreed with the physical exam findings, but insisted on an abdominal/pelvis CT (with IV and oral contrast). The CT revealed acute appendicitis with an appendiceal diameter of 1 cm 2014 17. Meta-analysis of the results of randomized (...) Completed: 1st July 2015 Last Modified: 1st July 2015 Status: Green (complete) Three Part Question In [children with suspected appendicitis ] is [POC US as good as radiology departmental ultrasound or CT scanning] at [safely shortening LOS in the emergency department]? Clinical Scenario An 8-year-old boy presents to the emergency department with right lower quadrant abdominal pain with features suggestive of appendicitis . The surgeons are not immediately available and suggest imaging 2015 Follow us: ©

2018 Trip Latest and Greatest

15. Suspected Appendicitis?Child

al [13] in their study of a staged clinical pathway using stratification per the Pediatric Appendicitis Score with US used in patients with an equivocal score (equal to 4–7) showed US to have 93% accuracy with 86% sensitivity and 97% specificity. US Abdomen There are no specific data regarding the relative performance of a focused RLQ US versus a complete abdominal US in intermediate-risk patients. US Pelvis There are no data specific to the use of pelvic US only in children with intermediate (...) diagnosis rate, however, is lower than what has been reported with both CT and MRI. US Abdomen There are no specific data related to whether a repeat focused RLQ US or a completed abdominal US is more effective in the setting of an initial equivocal US. ACR Appropriateness Criteria ® 8 Suspected Appendicitis–Child US Pelvis There are no data regarding the performance of pelvic US as a follow-up examination for acute appendicitis after a nondiagnostic RLQ US. In peri- or postmenarchal girls, a pelvic US

2019 American College of Radiology

16. CRACKCast E177 – Acute Complications of Pregnancy

and should always be considered in the differential diagnosis. The history and physical examination of the patient with ectopic pregnancy are insensitive and nonspecific, pelvic ultrasonography and serum hCG levels are essential to locate the pregnancy in any patient who has abdominal pain or vaginal bleeding and a positive pregnancy test result. Bleeding in Late Pregnancy Bleeding during the second trimester (14–24 weeks) is not benign and is associated with a 33% risk of fetal loss. Management (...) is supportive and expectant. Think: abruptio placentae and placenta previa. Patient history, physical examination, and results of ultrasonography can be used to distinguish them. All patients with painless, second-trimester vaginal bleeding should be assumed to have placenta previa until proven otherwise. Digital or instrumental probing of the cervix should be avoided until the diagnosis has been excluded via ultrasound. Abruptio placentae has a wide spectrum of severity of symptoms and risk. Up to 20

2018 CandiEM

17. Right Lower Quadrant Pain : Suspected Appendicitis

. Levy, MD k ; Daniele Marin, MD l ; Courtney Moreno, MD m ; Christine M. Peterson, MD n ; Christopher D. Scheirey, MD o ; Alan Siegel, MD, MS p ; Martin P. Smith, MD q ; Stefanie Weinstein, MD r ; Laura R. Carucci, MD. s Summary of Literature Review Introduction/Background Appendicitis is the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase despite reports (...) as an adjunct to help guide CT use [4,5]. Imaging remains the diagnostic mainstay in the workup of suspected appendicitis and RLQ abdominal pain. Modalities demonstrate high accuracy, which allows for: (1) the confident (and presumed early) diagnosis in positive cases, reducing delays in diagnosis and perforation with attendant morbidity and mortality; (2) the confident exclusion of the diagnosis in negative cases with a decrease in the NAR and the attendant potential surgical complications, and (3

2018 American College of Radiology

18. CRACKCast E093 – Appendicitis

% of female patient with appendicitis. A rectal examination contributes little toward the assessment of appendicitis and is not routinely recommended ” Here are the Top three: “RLQ tenderness; Abdominal wall rigidity; Pain focused at McBurney’s point” See wisecracks for the atypical presentations! 4) List 2 advantages and disadvantages each for CT and US in the diagnosis of appendicitis. What is the sensitivity/specificity of ↑WBC? Ultrasound: sensitivities of 75% to 90%, specificities of 83% to 95 (...) .” Low Risk PAS (<4) Low likelihood of acute appendicitis, and likely do not warrant imaging. The score has a higher negative predictive value (95%) in the absence of RLQ pain, pain with walking/jumping or coughing, and an ANC <6,750. Consider other causes of acute abdominal pain. Equivocal PAS (4-6) Imaging can be helpful for this subgroup of patients, preferably ultrasound or MRI for pediatric patients. Surgical consults are warranted for patients with equivocal scores and imaging where

2017 CandiEM

19. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis

infection, sepsis, intraperitoneal abscesses, and rarely death. 4 In order to avoid the sequelae of perforated appendicitis, a low percentage of “negative” appendectomies (i.e., removing a normal noninflamed appendix in patients mistakenly diagnosed with appendicitis) is generally accepted from a surgical standpoint. Clinical symptoms and signs suggestive of appendicitis include a history of central abdominal pain migrating to the right lower quadrant (RLQ), anorexia, fever, and nausea/vomiting (...) number is CRD42013006480. AHRQ TOO and External Stakeholder Input A panel of Key Informants, including patients and other stakeholders, gave input on the Key Questions to be examined. These Key Questions were posted on AHRQ’s Effective Health Care Web site for public comment and revised in response to comments. A Technical Expert Panel, including representatives of professional societies and experts in the diagnosis and treatment of RLQ abdominal pain and appendicitis, provided input to help further

2016 Effective Health Care Program (AHRQ)

20. A unique case of pediatric subhepatic appendicitis with elevated lipase. (PubMed)

of both right upper quadrant (RUQ) and right lower quadrant (RLQ) abdominal pain and serum lipase elevated four times the upper normal limit. The abdominal ultrasound was normal, except for prominent RLQ abdominal lymph nodes. Hours later, a computed tomography scan revealed a non-ruptured subhepatic appendicitis and normal pancreas. Our patient encounter demonstrates the need to be aware of the atypical presentations of pediatric appendicitis in general and subhepatic appendicitis in particular

2018 American Journal of Emergency Medicine

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