FITZ HUGH CURTIS SYNDROME
Clinical case Chief Complaints Pt is a 30 yr old house wife living in a slum area, is complaining of severe pain in lower abdomen high grade continous fever burning micturition and purulent vaginal discharge for 2 days She was given oral antibiotic and pain killer ( indomethacin) as suppository After 3 days she is hospitalized because of severe pain in right Hypochondrium which radiates to the right shoulder associated with vomiting and dry cough Vitals BP 90/60 Pulse 120 Temp 38.9C Physical Examination Inspection Looks ill dehydrated Palpation Liver enlarged Tender Hepatic rub present Percussion Stony dull in right lower chest Auscultation Right lower chest absent breath sound Investigations Suggest Diagnosis Differential diagnosis?
YES POSSIBLY CHRONIC MANIFESTATIONS. OF P I D PERIHEPATITIS AND .. ADHESIONS .LIVER. ABSCESS ACUTE CHOLECYSTITIS AND NEEDS FURTHER. EVALUATION
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Need Other test, USG abdmine, for burning Micturition, Rx Punarnavashtak qwath BD Galo ghan tab 1bd
Acute cholecystitis Liver Abscess
PID
? UTI .. ? GENITO-URINARY TRACT INFECTION.. ? PID.. NEED'S.. HEMOGRAM.. URINE ROUTINE.. VAGINAL SWAB C&S EXAMINATION.. USG..ABDOMEN..PELVIC .. GYNECOLOGICAL EXAMINATION WITH EXPERTS OPINION..
D/Dx Ruptured ectopic pregnancy. Hepatic abscess with Empyema thoracis. Disseminated gonococcal infection. Pyelonephritis. Appendicitis/perforated appendix Cholecystitis/perforated gall bladder.
UTI c PID/ Appendicular pain USG, Haemogram,Urine examination. Inj Tramadol,Inj Ondasteron,Inj Ceftriaxone. Tab cystone,syp Neeri, syp Alkasip,PID kit,Tab Azithral ,tab Rabezol-DM helpful..
P I D Inj Oflox iv drip Inj Metrogyl iv drip
Urinary tract infections (UTIs)
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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
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A male pt 24 yr complaing pain in right hypochondrium with liver tenderness, nausea , general weakness , abdominal fullness, anorexia, on investigation results in following plz suggest diagnosis and tmt.
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A newly married 25y/f having fever with chills/burning urination/severe constipation with vomiting ..especially morning Pregnancy -ve SGOP 53/ PT 45 Problems persistent even 3 days after oral Levoflox/ alkasip/pcm650/ paranorm/antacid/picosulf...
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