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Right Lower Quadrant Abdominal Pain

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1. 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 (...) sets. Estimated dose reduction ranged from 23% to 61%. The probability of correct diagnosis in limited pelvic sets was 68% as compared with 78% for limited abdomen sets [20]. Discussion of Procedures by Variant Variant 1: Right lower quadrant pain, fever, leukocytosis. Suspected appendicitis. Initial imaging. The “classic” clinical presentation of patients with appendicitis consisted of periumbilical abdominal pain migrating to the RLQ, loss of appetite, nausea or vomiting, with fever

2018 American College of Radiology

2. Diagnosis of right lower quadrant pain and suspected acute appendicitis

Diagnosis of right lower quadrant pain and suspected acute appendicitis Diagnosis of right lower quadrant pain and suspected acute appendicitis Diagnosis of right lower quadrant pain and suspected acute appendicitis Agency for Healthcare Research and Quality (AHRQ) Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Agency for Healthcare (...) Research and Quality (AHRQ). Diagnosis of right lower quadrant pain and suspected acute appendicitis. Rockville: Agency for Healthcare Research and Quality (AHRQ). Comparative Effectiveness Review No. 157. 2015 Authors' conclusions The literature on the test performance of clinical symptoms and signs, laboratory and imaging tests, and multivariable diagnostic scores for the diagnosis of acute appendicitis is large, but it consists almost exclusively of studies at moderate risk of bias, primarily

2016 Health Technology Assessment (HTA) Database.

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

Medical Center Harvard Medical School Boston, MA Daniel Dante Yeh, M.D. Massachusetts General Hospital Division of Trauma, Emergency Surgery and Surgical Critical Care Boston, MA vii Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis Structured Abstract Background. The reliable identification of patients with abdominal pain who need surgical intervention for acute appendicitis can improve clinical outcomes and reduce resource use. The test performance and impact on outcomes (...) 34. Other adverse events 113 Table 35. Reported surgical complications of diagnostic laparoscopy 116 Table 36. Assessment of the strength of evidence for test performance and modifiers of test performance 122 Table 37. Evidence gaps for the diagnosis of right lower quadrant abdominal pain and suspected acute appendicitis 127 Figures Figure A. Analytic framework ES-5 Figure B. Flow chart of included studies ES-10 Figure 1. Analytic framework 7 Figure 2. Flow chart of included studies 16 Figure 3

2016 Effective Health Care Program (AHRQ)

4. Right Lower Quadrant Abdominal Pain: Do Not Forget About Ovarian Torsion on the Computed Tomography Scan. (PubMed)

Right Lower Quadrant Abdominal Pain: Do Not Forget About Ovarian Torsion on the Computed Tomography Scan. Abdominal pain is one of the most common chief complaints of patients presenting to emergency departments, and emergency physicians (EPs) often evaluate patients with right lower quadrant abdominal pain. Ovarian torsion is a rare cause of abdominal pain, but early diagnosis is essential for salvage of the affected ovary. The diagnostic study of choice for ovarian torsion is a pelvic (...) ultrasound with color Doppler, but it is important for EPs and radiologists to be aware of findings of ovarian torsion that might appear on computed tomography (CT).We present a case of a young female with right lower quadrant abdominal pain with CT evidence of ovarian torsion that was not recognized; the patient was discharged and then called back when the study was over-read as concerning for ovarian torsion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The presence of radiographic findings

2018 Journal of Emergency Medicine

5. A rare case of right lower quadrant abdominal pain. (PubMed)

A rare case of right lower quadrant abdominal pain. Isolated fallopian tube torsion without involvement of the ovary is a rare condition most frequently presenting during reproductive years. Imaging, vitals, physical exam, and laboratory findings all fail to help establish a definitive diagnosis. The majority of the diagnoses are made on the operating table. Physical exam most often reveals unilateral and localized abdominal pain, often with nausea and vomiting, but few other reliably common (...) findings. Diagnosis becomes even more challenging due to the fact that isolated tubal torsion occurs often in pregnancy and preferentially on the right, further complicating the clinical picture. We describe a case of isolated tubal torsion, unique in that localized necrosis and inflammation from the torsion triggered a secondary appendicitis. The patient required surgical intervention, and an appendectomy and salpingectomy emergently. Given its elusive and rare nature, awareness and early intervention

2016 American Journal of Emergency Medicine

6. 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

7. When Fever, Leukocytosis, and Right Lower Quadrant Pain Is Not Appendicitis. (PubMed)

When Fever, Leukocytosis, and Right Lower Quadrant Pain Is Not Appendicitis. Mesenteric cystic lymphangioma (MCL) is an uncommon, benign, slow-growing abdominal tumor that is derived from the lymphatic vessels (World J Gastroenterol. 2012;18:6328-6332, Radiographics. 1994;14:729-737). It is most often diagnosed in the head and neck of affected children. Rarely, a lymphangioma can develop within the small bowel (Pan Afr Med J. 2012;12:7). The clinical presentation of patients with an abdominal (...) MCL can range from asymptomatic to acute abdominal pain (J Korean Surg Soc. 2012;83:102-106). We report a case of small bowel volvulus caused by an MCL in a 3-year-old child who presented to the pediatric emergency department with right lower quadrant pain. The child was thought to have a perforated appendicitis and was taken to the operating room where an MCL was identified and resected. This case illustrates the need to consider MCL when a patient presents to the emergency department with right

2017 Pediatric Emergency Care

8. Left Lower Quadrant Abdominal Pain

contrast Non- r cause suspected Evaluate for non-gastrointestinal cause as listed above VII. Imaging: Preferred with Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Left Lower Quadrant Abdominal Pain." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Gastroenterology About FPnotebook.com is a rapid access, point-of-care medical reference (...) 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

2018 FP Notebook

9. Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial. (PubMed)

Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial. The current research on acute appendicitis aims to improve the diagnostics and to clarify to whom antibiotic treatment might be the treatment of choice.The present study is a retrospective analysis of a prospectively collected data in our randomized multicenter trial comparing surgery and antibiotic treatment for acute uncomplicated appendicitis (APPAC trial (...) , NCTO1022567). We evaluated 1321 patients with a clinical suspicion of acute appendicitis, who underwent computed tomography (CT). Age, gender, body temperature, pain scores, the duration of symptoms, white blood cell count (WBC) and C-reactive protein (CRP) were recorded on admission.CT confirmed the diagnosis of acute appendicitis in 73% (n=970) and in 27% (n=351) it revealed no or other diagnosis. Acute appendicitis patients had significantly higher WBC levels than patients without appendicitis (median

2016 Clinical chemistry and laboratory medicine

10. Diagnostic characteristics of S100A8/A9 in a multicenter study of patients with acute right lower quadrant abdominal pain (PubMed)

Diagnostic characteristics of S100A8/A9 in a multicenter study of patients with acute right lower quadrant abdominal pain Over the past decade, clinicians have become increasingly reliant on computed tomography (CT) for the evaluation of patients with suspected acute appendicitis. To limit the radiation risks and costs of CT, investigators have searched for biomarkers to aid in diagnostic decision-making. We evaluated one such biomarker, calprotectin or S100A8/A9, and determined the diagnostic (...) performance characteristics of a developmental biomarker assay in a multicenter investigation of patients presenting with acute right lower quadrant abdominal pain.This was a prospective, double-blinded, single-arm, multicenter investigation performed in 13 emergency departments (EDs) from August 2009 to April 2010 of patients presenting with acute right lower quadrant abdominal pain. Plasma samples were tested using the investigational S100A8/A9 assay. The primary outcome of acute appendicitis

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2012 EvidenceUpdates

11. The NOTA Study (Non Operative Treatment for Acute Appendicitis): Prospective Study on the Efficacy and Safety of Antibiotics (Amoxicillin and Clavulanic Acid) for Treating Patients With Right Lower Quadrant Abdominal Pain and Long-Term Follow-up of Conser (PubMed)

The NOTA Study (Non Operative Treatment for Acute Appendicitis): Prospective Study on the Efficacy and Safety of Antibiotics (Amoxicillin and Clavulanic Acid) for Treating Patients With Right Lower Quadrant Abdominal Pain and Long-Term Follow-up of Conser To assess the safety and efficacy of antibiotics treatment for suspected acute uncomplicated appendicitis and to monitor the long term follow-up of non-operated patients.Right lower quadrant abdominal pain is a common cause of emergency (...) appendicitis are safe and effective and may avoid unnecessary appendectomy, reducing operation rate, surgical risks, and overall costs. After 2 years of follow-up, recurrences of nonoperatively treated right lower quadrant abdominal pain are less than 14% and may be safely and effectively treated with further antibiotics.

2014 Annals of Surgery

12. Right Upper Quadrant Pain

subset of conditions. Please see the ACR Appropriateness Criteria ® topic on “Jaundice” [1] that pertains specifically to this clinical scenario. Acute cholecystitis is the most frequent complication of gallstone disease, a common entity [2], and may be life- threatening; therefore, timely diagnosis is essential for proper treatment. Although most patients with acute cholecystitis experience right upper quadrant abdominal pain, nausea, vomiting, anorexia, and fever [2], information derived only from (...) and recommendations for this document specifically relate to the adult nonpregnant patient. Discussion of Procedures by Variant Variant 1: Right upper quadrant pain. Suspected biliary disease. Initial imaging. US Abdomen Ultrasound (US) is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain. It is very accurate at diagnosing or excluding gallstones with reported accuracy of 96% for detection of gallstones [2], and may differentiate cholelithiasis from gallbladder sludge

2013 American College of Radiology

13. Implementation of an Advanced Nursing Directive for Children With Right Lower Quadrant Pain: Identifying Those Requiring Further Investigation and Improving Flow Metrics. (PubMed)

Implementation of an Advanced Nursing Directive for Children With Right Lower Quadrant Pain: Identifying Those Requiring Further Investigation and Improving Flow Metrics. Advanced nursing directives (ANDs) empower nursing staff to provide advanced levels of care before physician assessment. The objectives of this study were (1) to determine whether an AND for right lower quadrant (RLQ) pain could identify children who required any further investigation to diagnose appendicitis and (2 (...) ) to determine whether children meeting AND criteria had better emergency department (ED) flow metrics compared with those who did not meet the criteria.Health records of children aged 3 to 17 years presenting to the ED with abdominal pain who were managed using the departmental AND for RLQ pain were reviewed. Primary outcomes included (1) the proportion of patients requiring further investigation to diagnose appendicitis and (2) the time interval from triage to blood draw. Secondary outcomes included

2015 Pediatric Emergency Care

14. Uncommon Surgical Causes Of Right Lower Quadrant Pain In Children. Single Center Experience. (PubMed)

Uncommon Surgical Causes Of Right Lower Quadrant Pain In Children. Single Center Experience. Right lower quadrant pain is one of the major reasons of children reference at the emergency department. The most common surgical cause, which needs appropriate management, is acute appendicitis. The purpose of this study is to reveal uncommon surgical causes found during surgery in children who were misdiagnosed as acute appendicitis in our department during the last 10 y. Data of patients who have (...) . All of the patients were successfully managed during the first operation. The possibility of other uncommon causes of right quadrant abdominal pain should always be kept in mind, especially when there is a negative appendicitis. However, the transaction of further paraclinical examinations - ultrasonography or computed tomography- preoperatively is under discussion. Nevertheless a thoroughly taken case history is undoubtedly always necessary.

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2015 Journal of clinical and diagnostic research : JCDR

15. Pediatric case of acute right-sided abdominal pain: diagnosis is not always appendicitis (PubMed)

or vomiting were present. Clinical examination revealed an adequately growing child following the 50th centile. She had severe generalized abdominal tenderness with rebound tenderness and guarding, mainly on the right lower abdominal quadrant, with all other system examinations normal. She had mildly increased inflammatory markers, and her initial abdominal ultrasound scan result was within normal limits. She had laparoscopic surgery following a diagnosis of suspected acute appendicitis; however (...) Pediatric case of acute right-sided abdominal pain: diagnosis is not always appendicitis Omental infarction (OI) is a rare cause of acute abdominal pain occurring in 0.1% of children, which is typically diagnosed during surgery for suspected appendicitis. We present the case of a 7-year-old Pakistani girl. She presented with acute, severe, progressive, right-sided abdominal pain, which was present for 12 hours before presentation. No constitutional symptoms such as fever, anorexia, nausea

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2017 Pediatric health, medicine and therapeutics

16. Acute Nonlocalized Abdominal Pain

]. Although in a nonpregnant patient the pain may follow a more reliable pattern (periumbilical or right lower quadrant), the location of pain may not correlate with presence of appendicitis in pregnant patients [86]. US is frequently the first imaging modality used in this scenario. Refer to the ACR Appropriateness Criteria ® topic on “Right Lower Quadrant Pain–Suspected Appendicitis” for further discussion [12]. Other causes of nontraumatic abdominal pain in pregnant women include urinary tract (...) preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology 2010;254:460-8. 65. Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg 2011;54:43- 53. 66. Ng CS, Palmer CR. Assessing diagnostic confidence: a comparative review of analytical methods. Acad Radiol 2008;15:584-92. ACR Appropriateness Criteria ® 16 Acute Nonlocalized Abdominal Pain

2018 American College of Radiology

17. 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

18. Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. (PubMed)

for cholecystectomy. For the restrictive strategy, cholecystectomy was advised for patients who fulfilled all five pre-specified criteria of the triage instrument: 1) severe pain attacks, 2) pain lasting 15-30 min or longer, 3) pain located in epigastrium or right upper quadrant, 4) pain radiating to the back, and 5) a positive pain response to simple analgesics. Randomisation was done with an online program, implemented into a web-based application using blocks of variable sizes, and stratified for centre (...) Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. International guidelines advise laparoscopic cholecystectomy to treat symptomatic, uncomplicated gallstones. Usual care regarding cholecystectomy is associated with practice variation and persistent post-cholecystectomy pain in 10-41% of patients. We aimed to compare the non-inferiority of a restrictive strategy

2019 Lancet

19. Clinical, Ultrasonographic, and Pathologic Characteristics of Patients with Chronic Right-lower-quadrant Abdominal Pain that May Benefit from Appendectomy. (PubMed)

Clinical, Ultrasonographic, and Pathologic Characteristics of Patients with Chronic Right-lower-quadrant Abdominal Pain that May Benefit from Appendectomy. Chronic pains of the right lower quadrant of the abdomen (RLQA) remain a challenging problem worldwide, especially in areas with limited technical background; chronic appendicitis is still a subject of controversy. The aim of this study was to analyze the clinical and paraclinical data of patients with chronic pains of RLQA who had (...) an appendectomy performed.During a period of 4 years, all patients presenting with a chronic pain of the RLQA were selected for our study and underwent clinical assessment and systematic ultrasonography of the abdomen; these served as a basis of selecting candidates for appendectomy. The intraoperative findings, histology results, and outcome after appendectomy were analyzed.Three hundred nineteen patients presented with chronic pains of the RLQA of which 213 could be finally analyzed; their mean age was 15.3

2011 World Journal of Surgery

20. Laparoscopic appendicectomy reduced chronic right lower-quadrant abdominal pain more than sham intervention

Laparoscopic appendicectomy reduced chronic right lower-quadrant abdominal pain more than sham intervention Laparoscopic appendicectomy reduced chronic right lower-quadrant abdominal pain more than sham intervention | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password (...) For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Laparoscopic appendicectomy reduced chronic right lower-quadrant abdominal pain more than sham intervention Article Text Therapeutics Laparoscopic appendicectomy reduced chronic

2008 Evidence-Based Medicine (Requires free registration)

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