What is the differential diagnosis
Clinical Discussion Questions
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What is the differential diagnosis?
Based on the data, one of the differential diagnoses would be Bacterial Gastroenteritis (Sattar & Singh, 2018). The main symptoms of the disease include nausea, vomiting, diarrhea and belly pains. The client shows all these making it a disease to consider. Also, the ROS exhibits all these symptoms and the details the client explained in the clinic. The other differential diagnosis would be Appendicitis. The support for this is the availability of McBurney’s point. That entails the swelling of the lower right quadrant of the belly. There is also the availability of tenderness. Acute appendicitis has all these characteristics whereby there is tenderness at a particular place in the lower abdomen.
The third diagnosis would be Gastritis. Gastritis usually leads to nausea, vomiting, and burning pain. That is because the condition occurs when a person’s stomach lining is inflamed or the mucus lining in the stomach has problems. The last differential diagnosis would be a Small Bowel Obstruction. The condition occurs due to the obstruction of the small intestines, resulting in some of the client’s symptoms. These symptoms include vomiting, nausea, stomach pains, and lack of appetite. All these conditions are possible, and it is appropriate to consider each before ruling out.
What is the most likely diagnosis? Why?
Acute Appendicitis would be the most likely diagnosis (Di Saverio et al., 2020). The main reason is that all the significant symptoms of the condition are available to the client. Mainly, the condition occurs when the appendix is inflamed or affected. Once the organ has complications, it leads to pains in the lower abdomen. Moreover, the condition leads to nausea, vomiting, and McBurney’s point. Based on the physical examination, the client had a tender abdomen, especially in the lower quadrant. Thus, tenderness in McBurney’s point is an indication of Appendicitis. The point shows that the appendix inflammation is no longer in the bowel, and Acute Appendicitis is at its final stage.
Moreover, psoas sign + is an indication that there is an inflamed appendix that overlies on the psoas muscle. That is why the Rovsing’s sign is questionable in this case. Rovsing’s sign indicates that there are high chances of Acute Appendicitis. A positive Rovsing’s sign is marked by pain in the lower abdomen after palpation. All these signs are available on the client, a convincing and supporting stance that the 17-year-old suffers from appendicitis.
3. Demonstrate your understanding about the pathophysiology in regard to the most likely
diagnosis?
The pathophysiology of Acute Appendicitis usually arises from the blockage of the appendiceal orifice. Once the opening is blocked, it can multiply bacteria in the appendix, leading to acute inflammation. The reduced drainage from the organ can lead to high pressure, leading to ischemia. After that, the inflamed appendix grows in size and increases inflammatory effects in the tissues within. These effects or changes include tenderness, as evident in the client. Lastly, the inflammation makes the appendix have a retrocausal positioning (Jones et al., 2018).
What are the next appropriate steps in management?
The management and treatment of Acute Appendicitis need considerate attention. The initial step would be nonoperative management with the use of antibiotics. The therapy aims to avoid surgeries, but surgery is the next step if the disease resists antibiotics. Appendectomy would be the surgical treatment for the condition. Moreover, laparoscopic surgery would be effective for quick recovery and less pain (Jones et al., 2018). However, appendectomy would be the appropriate intervention in the case of raptures. After the interventions, the patient must observe the doctor’s guidelines to ensure recovery and remain fit. Drinking a lot of water would help reduce constipation, relaxing and avoiding complex tasks would help not to strain belly muscles and following dietary options given by the doctor. All these will help manage the condition, and the body will resume normal functions without the appendix.
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