A 28 yrs male patient came in ER with c/o severe abdominal pain vitals stable Abd distended xray abd erect done as shown here spot Dx ???

The Differential Diagnosis Of Appendicitis Is Often Challenging- Why? The overall accuracy for diagnosing acute appendicitis is approximately 80%, corresponding to a mean negative appendectomy rate of 20%. Diagnostic accuracy varies by sex, with a range of 78-92% in male patients and 58-85% in female patients. The classic history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain, and vomiting occurs in only 50% of cases. Vomiting that precedes pain is suggestive of intestinal obstruction, and the diagnosis of appendicitis should be reconsidered. The differential diagnosis of appendicitis is often a clinical challenge because appendicitis can mimic several abdominal conditions. Patients with many other disorders present with symptoms similar to those of appendicitis, such as the following: Surgical Intestinal obstruction Intussusception Acute cholecystitis Perforated peptic ulcer Mesenteric adenitis Meckel's diverticulitis Colonic/appendicular diverticulitis Pancreatitis Rectus sheath haematoma Urological Right ureteric colic Right pyelonephritis Urinary tract infection Gynecological Ectopic pregnancy Ruptured ovarian follicle Torted ovarian cyst Salpingitis/pelvic inflammatory disease Medical Gastroenteritis Pneumonia Terminal ileitis Diabetic ketoacidosis Preherpetic pain on the right 10th and 11th dorsal nerves Porphyria Misdiagnosis in women of childbearing age Appendicitis is misdiagnosed in 33% of nonpregnant women of childbearing age. The most frequent misdiagnoses are pelvic inflammatory disease (PID), followed by gastroenteritis and urinary tract infection. In distinguishing appendiceal pain from that of PID, anorexia, and onset of pain more than 14 days after menses suggests appendicitis. Previous PID, vaginal discharge, or urinary symptoms indicate PID. On physical examination, tenderness outside the RLQ, cervical motion tenderness, vaginal discharge, and positive urinalysis support the diagnosis of PID. Although negative appendectomy does not appear to adversely affect maternal or fetal health, diagnostic delay with perforation does increase fetal and maternal morbidity. Therefore, an aggressive evaluation of the appendix is warranted in pregnant women. The level of urinary beta-human chorionic gonadotropin (beta-hCG) is useful in differentiating appendicitis from an early ectopic pregnancy. However, with regard to the WBC count, physiologic leukocytosis during pregnancy makes this study less useful in the diagnosis than at other times, and no reliable distinguishing WBC parameters are cited in the literature. Also, Read  COVID-19 Differential Diagnosis    

29F h/o Abd pain for 1day h/o fever no h/o vomiting wt could be possible diagnosis?

45/F presented to ER with c/o Right upper & lower quadrant severe abdominal pain since 12.30 midnight a/w vomiting - 6 episodes h/o right flank pain radiating to lower abdomen. h/o palpitation+ no h/o fever/decreased urine output / burning micturition. ECG done showed this changes diagnosis and treatment?

A 25 y/o female presented to emergency department with a c/o of abdominal pain since 6 days and abdominal distension since 4 days with absence of passage of stool. However she doesnt complain of fever,SOB and has no h/o DM, hypertension. She had medically induced abortion 3 months back. O/E GC: ill looking P/A: rigidity and guarding present CNS ,CVS and respi: NAD All her laboratory investigations along with chest xray and abdominal x ray in upright and supine postition and USG are given below. What is the probable diagnosis?