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dx.
Clinical Reference
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Interpretation guide
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Right Lower Quadrant Pain
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Right Lower Quadrant Pain
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
Context and trajectory
Symptom context
▶
Time course
Baseline health before onset
First episode
Recurrent episodes
Prior similar evaluation
Current symptom trajectory
Onset
Onset features
▶
Sudden onset
Gradual onset
Initial pain location
Migration to right lower quadrant
Provocation/Palliation
Provoking factors
▶
Movement
Coughing
Bumps in car ride
Urination
Bowel movement
Eating
Relieving factors
▶
Stillness
Analgesics taken
Antiemetics taken
Quality
Pain quality
▶
Sharp
Dull
Cramping
Colicky waves
Burning
Region/Radiation
Pain location and spread
▶
Right lower quadrant maximal tenderness
Suprapubic component
Flank component
Groin radiation
Back radiation
Shoulder radiation
Severity
Severity pattern
▶
Mild
Moderate
Severe
Worsening over hours
Worsening over days
Timing
Timing characteristics
▶
Constant pain
Intermittent pain
Nocturnal awakening
Postprandial timing
Menstrual cycle timing
Associated symptoms
Gastrointestinal symptoms
▶
Anorexia
Nausea
Vomiting
Diarrhea
Constipation
Obstipation
Hematochezia
Melena
Constitutional symptoms
▶
Fever
Chills
Malaise
Genitourinary symptoms
▶
Dysuria
Urinary frequency
Urgency
Hematuria
Flank pain
Gynecologic symptoms
▶
Pregnancy possibility
Vaginal bleeding
Vaginal discharge
Dyspareunia
Last menstrual period timing
Testicular symptoms
▶
Testicular pain
Scrotal swelling
Special populations history
Pregnancy related considerations
▶
Known pregnancy status
Prior ectopic pregnancy
Assisted reproduction history
Pediatrics and adolescents considerations
▶
Pain localization reliability
Caregiver observed symptoms
Older adult considerations
▶
Atypical minimal tenderness
Baseline cognitive impairment
Alarm Features
Immediate escalation triggers
High risk physiology
▶
Systolic blood pressure under 90 mmHg
Heart rate at least 120 beats per minute
Respiratory rate at least 24 breaths per minute
Oxygen saturation under 92 percent on room air
Temperature at least 38.5 C
Altered mental status
High risk abdominal findings
▶
Peritonitis
Rebound tenderness
Involuntary guarding
Rigid abdomen
Distension with vomiting
Severe pain out of proportion
High risk historical features
▶
Syncope
Sudden maximal pain at onset
Persistent vomiting with dehydration
Immunocompromised state
Anticoagulation use
Pregnancy and gonadal threats
▶
Positive pregnancy test with pain
Heavy vaginal bleeding
Severe unilateral pelvic pain
Sudden testicular pain
High riding testis
Absent cremasteric reflex
Medications
Medication exposures and interactions
Analgesics and antipyretics
▶
NSAIDs
Acetaminophen
Opioids
Anticoagulants and antiplatelets
▶
Warfarin
Direct oral anticoagulants
Heparins
Aspirin
P2Y12 inhibitors
Recent antibiotics
▶
Within last 30 days
C difficile risk exposure
Hormonal and reproductive medications
▶
Oral contraceptives
IUD
Fertility treatments
High risk medication classes
▶
Steroids
SGLT2 inhibitors
Immunosuppressants
Contrast related risk modifiers
▶
Metformin
Prior contrast reaction
Diet
Intake and exposures
Recent intake pattern
▶
Poor oral intake
Normal intake
Recent heavy meal
Recent fasting
Hydration indicators
▶
Reduced urine output
Thirst
Orthostatic symptoms
Foodborne exposure risks
▶
Undercooked meat
Unpasteurized foods
Sick contacts with gastroenteritis
Caffeine and stimulant exposure
▶
High caffeine intake
Energy drinks
Alcohol exposure
▶
Recent binge
Daily use pattern
Review of Systems
System review
General
▶
Fever
Chills
Weight loss
Fatigue
Gastrointestinal
▶
Nausea
Vomiting
Diarrhea
Constipation
Obstipation
Bloody stool
Genitourinary
▶
Dysuria
Frequency
Hematuria
Flank pain
Gynecologic
▶
Vaginal bleeding
Vaginal discharge
Pelvic pain
Missed period
Respiratory and cardiovascular
▶
Chest pain
Dyspnea
Palpitations
Syncope
Neurologic
▶
Headache
Weakness
Confusion
Collateral History and Family History
Context and inherited risks
Collateral source
▶
Family report
Caregiver report
EMS report
Reliability concerns
Family history relevant to right lower quadrant pain
▶
Inflammatory bowel disease
Colorectal cancer
Nephrolithiasis
Thrombophilia
Exposure context
▶
Household gastroenteritis
Recent travel exposure
Foodborne outbreak exposure
Risk Factors
Patient and exposure risks
Appendicitis and perforation risk
▶
Symptom duration over 48 hours
Immunosuppression
Older age
Gynecologic infection risk
▶
New sexual partner
Prior PID
No barrier contraception
IUD insertion recent
Ectopic pregnancy risk
▶
Prior ectopic pregnancy
Prior tubal surgery
Prior PID
Assisted reproduction
Nephrolithiasis risk
▶
Prior stones
Low fluid intake
High heat exposure
Hernia risk
▶
Prior hernia
Heavy lifting
Prior abdominal surgery
Vascular catastrophe risk
▶
Known aortic aneurysm
Marfan syndrome
Ehlers Danlos syndrome
Cocaine or stimulant use
Uncontrolled hypertension
Differential Diagnosis
Life threatening
Cannot miss causes
▶
Appendicitis with perforation or abscess (K35.2)
▶
Worsening pain
Peritonitis
Fever
Leukocytosis
Ectopic pregnancy (O00.9)
▶
Positive pregnancy test
Vaginal bleeding
Syncope
Shoulder pain
Ovarian torsion (N83.5)
▶
Sudden severe unilateral pelvic pain
Nausea
Adnexal mass risk
Testicular torsion (N44)
▶
Sudden testicular pain
High riding testis
Absent cremasteric reflex
Bowel obstruction with ischemia (K56.6)
▶
Distension
Persistent vomiting
Obstipation
Peritonitis
Mesenteric ischemia (K55.9)
▶
Pain out of proportion
Lactate elevation
Abdominal aortic aneurysm rupture (I71.3)
▶
Hypotension
Back pain
Pulsatile mass
Aortic dissection with abdominal malperfusion (I71.0)
▶
Sudden onset pain
Pulse deficit
Neurologic symptoms
Common
Frequent causes
▶
Uncomplicated appendicitis (K35.80)
▶
Migration to right lower quadrant
Anorexia
Fever
Localized tenderness
Gastroenteritis (A09)
▶
Diarrhea
Sick contacts
Constipation (K59.00)
▶
Reduced stool output
Hard stools
Ureterolithiasis (N20.0)
▶
Colicky pain
Hematuria
Flank to groin radiation
Urinary tract infection (N39.0)
▶
Dysuria
Positive urine leukocyte esterase
Pyelonephritis (N10)
▶
Fever
Flank pain
Costovertebral angle tenderness
Pelvic inflammatory disease (N73.9)
▶
Cervical motion tenderness
Vaginal discharge
Ruptured ovarian cyst (N83.209)
▶
Sudden unilateral pelvic pain
Free fluid on ultrasound
Inguinal hernia (K40.90)
▶
Groin bulge
Pain with lifting
Less common
Important alternatives and mimics
▶
Crohn disease flare or ileitis (K50.90)
▶
Chronic diarrhea
Weight loss
Perianal disease
Cecal diverticulitis (K57.32)
▶
Right sided localized tenderness
CT colonic diverticula
Epiploic appendagitis (K63.89)
▶
Localized pain
Minimal systemic symptoms
Meckel diverticulitis (Q43.0)
▶
Pediatric or young adult
Bleeding possible
Psoas abscess (K68.12)
▶
Fever
Hip pain
Pain with hip extension
Abdominal wall pain
▶
Pain with tensing abdominal muscles
Focal superficial tenderness
Endometriosis
▶
Cyclic pain
Dyspareunia
Past Medical History
Prior conditions and procedures
Relevant chronic conditions
▶
Inflammatory bowel disease
Prior appendicitis
Prior nephrolithiasis
Recurrent urinary tract infections
Prior PID
Known ovarian cysts
Known abdominal aortic aneurysm
Surgeries and procedures
▶
Prior abdominal surgery
Prior hernia repair
Prior cesarean delivery
Prior tubal surgery
Baseline status
▶
Baseline bowel pattern
Baseline urinary pattern
Baseline pain tolerance
Devices
▶
Intrauterine device
Ureteral stent
Physical Exam
Initial appearance and vitals
General assessment
▶
Ill appearance
Toxic appearance
Diaphoresis
Dehydration signs
Vital sign interpretation
▶
Fever pattern
Tachycardia disproportionate
Hypotension
Orthostasis
Abdominal exam
Inspection and auscultation
▶
Distension
Surgical scars
Bowel sounds absent
Bowel sounds high pitched
Palpation and percussion
▶
Right lower quadrant tenderness
McBurney point tenderness
Rebound tenderness
Guarding
Percussion tenderness
Mass
Peritoneal maneuvers
▶
Rovsing sign
Psoas sign
Obturator sign
Heel drop pain
Genitourinary and pelvic exam
Pelvic exam when indicated
▶
Cervical motion tenderness
Adnexal tenderness
Adnexal mass
Vaginal discharge
Vaginal bleeding
External genital exam
▶
Groin hernia bulge
Scrotal swelling
Testicular exam when indicated
Torsion focused findings
▶
Testis position
Cremasteric reflex
Prehn sign limited utility
Cardiovascular and vascular exam
Perfusion and pulses
▶
Pulse symmetry
Capillary refill delay
Cool extremity
Aortic catastrophe clues
▶
New murmur
Focal neurologic deficit
Focused pitfalls
Atypical presentations
▶
Minimal tenderness in older adults
Minimal fever in immunosuppressed patients
Pain out of proportion pattern
Lab Studies
Core labs
Inflammatory and infection evaluation
▶
CBC
Neutrophilia interpretation
CRP
Procalcitonin local protocol dependent
Metabolic evaluation
▶
Electrolytes
Creatinine for contrast planning
Liver enzymes for alternative diagnosis
Pregnancy evaluation
▶
Urine pregnancy test
Serum beta hCG if pregnancy suspected
Urinary evaluation
▶
Urinalysis
Urine microscopy for hematuria
Urine culture triggers
Sepsis and ischemia evaluation
Perfusion markers when high risk
▶
Lactate
Venous blood gas when shock suspected
Blood cultures when febrile and toxic
Gynecologic and STI evaluation
Infection testing when indicated
▶
NAAT for gonorrhea
NAAT for chlamydia
Vaginal wet mount local protocol dependent
Imaging
Scoring Systems
Appendicitis risk scores for selection of imaging and consultation
▶
Alvarado score
▶
Low risk range supports observation and alternative diagnosis workup
Intermediate risk supports imaging
High risk supports early surgical consultation
Appendicitis Inflammatory Response score
▶
Intermediate risk supports imaging
High risk supports early surgical consultation
Pediatric Appendicitis Score
▶
Use in pediatrics and adolescents
Avoid using score alone to rule out appendicitis
MRI
MRI abdomen pelvis for appendicitis
▶
Pregnancy with equivocal ultrasound
Contrast avoidance considerations
Limitations
Availability dependent
CT
CT abdomen pelvis for appendicitis and complications
▶
IV contrast protocol for suspected appendicitis
Oral contrast usually not required local protocol dependent
Findings supporting appendicitis
Findings supporting perforation
CT for urinary stone evaluation
▶
Noncontrast CT when ureterolithiasis likely
Radiation reduction protocols when available
CT angiography for vascular catastrophe when suspected
▶
Aortic dissection concern
Abdominal aortic aneurysm concern
Mesenteric ischemia concern
Ultrasound
Right lower quadrant ultrasound
▶
First line in children and pregnancy when feasible
Nonvisualized appendix limitations
Secondary signs
Transvaginal ultrasound with Doppler
▶
Ectopic pregnancy evaluation
Ovarian torsion evaluation
Hemoperitoneum screening
Renal ultrasound
▶
Hydronephrosis screening
Alternative in pregnancy
Special Tests
Bedside maneuvers and procedural diagnostics
Abdominal wall pain evaluation
▶
Carnett sign supportive of abdominal wall source
Focal superficial tenderness pattern
Pelvic infection evaluation
▶
Cervical motion tenderness significance
Uterine tenderness significance
Adnexal tenderness significance
Testicular torsion evaluation
▶
Manual detorsion only if immediate ultrasound and surgery delayed local protocol dependent
Emergent urology consultation triggers
Point of care ultrasound
Focused POCUS targets
▶
Free fluid in pelvis
Hydronephrosis
Abdominal aorta screening in appropriate age and risk
ECG
When ECG changes management
Indications in right lower quadrant pain
▶
Older age
Significant tachycardia
Syncope
Chest pain
Severe electrolyte abnormality risk from vomiting
High risk ECG patterns
▶
Ischemic ST changes
Hyperkalemia patterns
Prolonged QT interval with antiemetic use risk
Assessment
Problem synthesis and risk stratification
Working diagnosis selection
▶
Appendicitis concern with risk tiering
Renal colic concern with complication screen
Gynecologic emergency concern with pregnancy status
Severity stratification
▶
Peritonitis present
Sepsis physiology present
Uncontrolled pain
Persistent vomiting with dehydration
Complications to exclude
▶
Appendiceal perforation or abscess
Ectopic pregnancy rupture
Ovarian torsion necrosis risk
Obstruction with ischemia
Diagnostic uncertainty handling
▶
Observation pathway with repeat exams
Repeat labs and imaging triggers
Plan
First 5 minutes and stabilization
Immediate priorities
▶
Cardiac monitor when unstable
Two large bore IV when shock suspected
Crystalloid bolus if hypotensive
NPO if surgical abdomen possible
Analgesia and antiemetics
▶
Acetaminophen PO or IV dosing per local protocol
NSAID if renal function acceptable and no bleeding risk
Opioid for severe pain with reassessment loop
Ondansetron dosing per local protocol
Diagnostic sequencing
Pregnancy first approach for people who can be pregnant
▶
Urine pregnancy test early
Immediate ultrasound pathway if positive pregnancy test and pain
Appendicitis pathway
▶
Risk score to guide imaging and consultation
Ultrasound first in children and pregnancy when feasible
CT abdomen pelvis when ultrasound nondiagnostic and suspicion persists
Renal colic pathway
▶
Urinalysis for hematuria and infection
Imaging selection based on risk and pregnancy
Infection with obstruction triggers emergent urology consultation
Therapeutics
Antibiotics when appendicitis complicated or sepsis suspected
▶
Broad spectrum coverage per local protocol
Allergy guided alternatives per local protocol
Pelvic inflammatory disease empiric treatment when criteria met
▶
Ceftriaxone dosing per local protocol
Doxycycline dosing per local protocol
Metronidazole dosing per local protocol
Renal colic management
▶
NSAID first line when not contraindicated
Tamsulosin for distal ureteral stone local protocol dependent
Hydration guided by volume status
Consultation and reassessment loop
Consultation triggers
▶
Surgery for suspected appendicitis with high risk features
Gynecology for suspected ectopic pregnancy or ovarian torsion
Urology for obstructing stone with infection or acute kidney injury
Reassessment loop
▶
Repeat vitals within 30 to 60 minutes when unstable or escalating pain
Repeat abdominal exam after analgesia
Escalate imaging or consult if new peritoneal signs
Disposition
Level of care and follow up criteria
Copy
ICU or resuscitation area criteria
▶
Shock requiring ongoing fluid resuscitation or vasopressors
Sepsis with organ dysfunction
Altered mental status
Inpatient admission criteria
▶
Suspected appendicitis
Complicated diverticulitis
Pyelonephritis with instability
Inability to tolerate oral intake
Uncontrolled pain requiring parenteral therapy
Observation pathway criteria
▶
Intermediate appendicitis risk with equivocal imaging
Need for serial exams
Need for repeat labs
Discharge criteria
▶
Stable vitals
Pain controlled on oral regimen
Tolerating oral fluids
No peritoneal signs
Reliable follow up
Clear return precautions provided
Discharge Instructions
Copy discharge instructions
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What we think is happening
▶
Your pain may be from a condition that can change over time
Some serious causes may not show early
Medications
▶
Take prescribed pain medicine only as directed
Do not drive after sedating medicines
Avoid NSAIDs if you were told you have kidney problems or bleeding risk
Fluids and food
▶
Drink enough fluids to keep urine light yellow unless you were told to limit fluids
Start with small bland meals as tolerated
Follow up
▶
Follow up with your primary care clinician within 24 to 72 hours
Follow up sooner if symptoms worsen
Return to emergency care now if any of these happen
▶
Worsening belly pain
New severe pain
Fainting
Fever
Repeated vomiting
Black stool
Bloody stool
New vaginal bleeding
New testicular pain
New chest pain
Shortness of breath
References
Guidelines and decision tools
American College of Radiology Appropriateness Criteria Right Lower Quadrant Pain Suspected Appendicitis
▶
Imaging selection across adult and pediatric populations
Pregnancy imaging pathways included
World Society of Emergency Surgery guidelines for acute appendicitis 2020
▶
Risk stratification
Imaging strategy
Antibiotic and operative pathways
American College of Obstetricians and Gynecologists guidance on ectopic pregnancy evaluation and management
▶
Ultrasound and beta hCG interpretation
Time critical consultation triggers
American Urological Association guideline for ureteral stones
▶
Analgesia and medical expulsive therapy context
Indications for urgent intervention
American College of Emergency Physicians clinical policy topics on abdominal pain imaging and evaluation local protocol dependent
▶
CT use considerations
Shared decision making when low risk
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Right Lower Quadrant Pain