What is the probable intial diagnosis?

Clinical case Chief Complaints A woman aged 46 yr old presented with severe pain in right hypochondrium and right loin for 3 days. History She was treated with analgesic but pain continued with disturbance of sleep. She was afebrile. There was tenderness in the right hypochondrium and right loin Intial investigation Chest xray and abdomen are normal WBC 26700 poly 90% lympho 10% After 5 days the pain is more severe which radiates to the right loin groin and inner thigh Vitals Temp 40 C Physical Examination Pt is very toxic ill looking lying with right leg flexed Right loin and groin very tender Investigations Suggest Diagnosis What is the probable intial diagnosis? Management Discuss drs

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? GALLSTONES.. CHOLECYSTITIS.. ? ENTERITIS.. COLITIS.. ? RENAL CALCULI.. UTI.. ? APPENDICITIS.. ? UTERINE PATHOLOGY.. ? OVARIAN PATHOLOGY.. NEED'S.. CLINICOPATHOLOGICAL EVALUATION WITH.. USG..ABDOMEN.. CTCE STUDY ABDOMEN..

I think Ultrasonography is such a simple investigation - which should be done all such cases- As abdomen is Pandora's BOX and most of the organs,in the body are in the abdomen If USG is done following D/D can be diagnosed 1 Acute cholecystitis with cholelithiasis 2.Renal or ureteric calculi with colic 3.Acute appendicitis 4 Right ovarian pathology

SUGGESTIVE. OF ... SEPSIS POSSIBLY BACTERIAL. INFECTION DIFFERENTIALS... .. 1 AC. RENAL. INFECTION WITH. RENAL. COLIC.. 2... ACUTE TUBO OVARIAN. .INFECTION / ABSCESS P. I. D. .... 3... AC. APPENDICITIS

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Origin of pain possibly from, gall bladder Large bowel, ovary, renal stone, appendix. Psoas abscess. Needs to evaluate the pathology causing sepsis & shock.

? Appendicitis. ? Renal colic. ? Enteritis. colitis. ? Uterine pathology. ? RT . overian pathology. ? Gall bladder pathology. AD. USG Study. CTCE Study..l

D/D Acute cholecystitis Acute hepatitis Acute U T I Acute pancreatitis Further evaluation is required for diagnosis

Indeed appendicitis Infection is more than enough Suggest for appendectomy

? Appendicitis... ? Right renal stone with hydronephrosis.. ? Right pyelonephritis.. ? Cholelithiasis.. Abdominal Koch's... Adv USG abdomen and pelvis and chest x-ray..

Thank you doctor
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Inv req- USG and cect whole abdomen , rft,lft, ecg, viral markers,pt,inr, repeat cbc, D/d ?Cholelithiasis with cholecystitis ?Enteritis colitis ?renal colic with UTI ?uterine or ovarian pathology ?burst appendix with peritonitis ?PID Treatment Start with inj tazact 4.5gm iv 8hrly inj meteogyl 100ml iv 8hrly , analgesic, and plan further acc. To inv reports.

Agree with @Kute Ankush @Pushker Bhomia after diagnosis, will plan medicationa and further procedure Appendicitis? Renal Calculi ?

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