Thank you, this is truly good case

I hope of our young doctors to try to analyse the history and the clinical findings

DEAR DR

IS IT RADIATING OR SHIFTTING FROM UMBILICAL TO RLQ
Left lower Quadrant area patient felt tenderness on Right Lower Quadrant area -- OR PAIN
WITH GREAT THANKS

first of all I would like to thank you Dr for this case for which you deserve +2 points
secondly , let's don't just give merely a diagnosis . instead let's learn how to approach this patient an what managment should we provide her

as the problem started 2 days ago so it's an acute one
the diffrintial diagnosis include : appendicitis , IBS , colitis , urinary stone , gynaecological problem

the radiation of the pain is consistent with appendicitis but the coliky nature may tip the balance in favor of urinary or biliary stones

nausea and vomiting are non specific symptomes

the fact that : With deep palpation on Left lower Quadrant area patient felt tenderness on Right Lower Quadrant area
suggest peritonial irritation so I have to ask you is her abdomin solid
? suggesting an acute abdomin

I don't know what OCP stand for !!!!!!!!!!!!! can you please tell us the full name

the fact the patient is afebrile can exclude inflammatory processes which makes the case more complicated

the increased bowel sounds is a sign of mechanical obstruction which maybe the result of impacted biliary stone

If I faced such a patient i'll refer her to a general surgeon

thank you for your response

Now I am gonna try to make this subject so good for disscution

***dr_amincops:cool:

1-What dose the difference if this pain was radiated or shifted
2- the second thing you asked, yes the lady felt pain in RLQ with constant pressure in LLQ


***Abo Alqassem
If I faced such a patient i'll refer her to a general surgeon
Because of that I am a SURGEON:chris:
Let me clarify some points

1- you are absolutlu right, this Acute problem
2- your DDx is so good but ( Urinary stone ) is still away because in the Hx I wrote NO URINARY SYMPTOMS
3- the colicky nature of pain dosent mean only urinary problem you Know that colicky nature reflects any pain in any hollow organ
4- nausea and vomiting are playing role here my bro
5-in the Examination I mentioned that the abdomin not distended :d So it is not solid
6- OCP means Oral Contaceptive Pill ( sorry about that stand:giggle: )
7- +ve bowel sound dosent mean increased it


Finally you are still have good thinking and with above information I will wait to read your reply

مشكورين جميعا على هذا النقاش المفيد

بصراحة الفائدة منه كبيرة جداً وأتمنى أن تفيدونا بمزيد من الحالات في المستقبل

+ 2 لكل منكم

Thank you dr_rshama

you did great approach to this case and it is benifits that we are looking for
( I have one position for you in my team:d )

so
for all those have been red this disscution
what is the final Dx that you think

Waaaaaaaaaaaaaaaaaaaaaaaaaaaa

Please............Please.................noooooooooooooooooooo

( I have one position for you in my team )

How can you drop me down in a surgical team???????????? am I your enemy

I respect you a lot BUT

Please forgive me and do not take me there

No you arn't my enemy But my best friend how can I do my job without your help (Internist)

So you are my bro