Question

A 46-year-old man presents to the emergency department with nausea, vomiting, constipation for the past 2 days. He also complains of abdominal pain that initially started at the periumbilical area then traveled to the right lower quadrant. He is tachycardic, febrile, and mildly hypertensive on examination. A physical examination demonstrates a diffusely tender abdominal with rebound, especially at the right lower quadrant. What is the diagnosis?

Answer 1

The symptoms described by the 46-year-old man strongly suggest acute appendicitis, which is characterized by periumbilical pain migrating to the right lower quadrant, accompanied by nausea, vomiting, and constipation, in addition to fever and tachycardia.

Step-by-step explanation:

The 46-year-old man's clinical presentation is most consistent with acute appendicitis. Appendicitis typically begins with abdominal pain that may start around the navel and then shifts to the right lower quadrant. The pain is often accompanied by nausea, vomiting, and constipation or diarrhea. Fever, tachycardia (elevated heart rate), and mild hypertension can also occur.

The presence of a diffusely tender abdomen with rebound tenderness, especially in the right lower quadrant, further supports the diagnosis of appendicitis. However, it is important to consider other differential diagnoses, such as gastroenteritis, renal colic due to urinary stones, inflammatory diseases like diverticulitis, or even conditions leading to infection or inflammation post-surgery (as with Roberta's cholecystectomy).

In light of the symptoms described, and the high risk of complications such as perforation and peritonitis associated with appendicitis, prompt diagnostic imaging (e.g., abdominal ultrasound or CT scan) should be considered to confirm the diagnosis and surgical intervention may be required.