Determine the pH of any vaginal discharge and make wet mount examinations and Gram stains of endocervical secretions, looking for Candida organisms, Trichomonas organisms, leukocytes, and clue cells (see Chapter 95). It is also non-invasive. The clinical pattern may be that of an acute secondary illness occurring after surgery for primary abdominal disease or prolonged recuperative course in a patient who has been receiving antibiotics after abdominal surgery. Ectopic pregnancy is seen when a fetus forms outside the uterus. One of the most specific criteria for diagnosing PID is the finding of thickened, fluid-filled tubes with or without free pelvic fluid on transvaginal sonography. Toxic megacolon can complicate any of the infectious colitides, e.g. When retroperitoneal hemorrhage has occurred, ecchymoses in the flank (Grey–Turner sign) or periumbilically (Cullen's sign) may be observed. What are the Differences Between Durum Wheat and Whole Wheat? Your doctor will insert a laparoscope into your abdomen. In addition, it is critical to document weight and compare the present objective measurement of weight observed over time as unexpected weight loss in the setting of chronic diarrhea may point toward a malignant or malabsorptive etiology. Appendicitis: may be diffuse abdominal pain, but tenderness should be right lower quadrant. This is usually diagnosed from the region of the right lower quadrant. It usually comes with feelings of soreness and tenderness. Subtle findings may include only a history of abnormal uterine bleeding, dyspareunia, vaginal discharge, or cervical purulence. Doctors use it to help diagnose peritonitis or rule out other conditions. Health Benefits and Nutrition Facts of Watermelon. Treat suspected cases while awaiting diagnostic confirmation. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Give cefotetan, 2 g IV every 12 hours, or cefoxitin, 2 g IV every 6 hours, plus doxycycline, 100 mg orally or IV every 12 hours. There is another part to this, more like the exact opposite phenomenon and it is called Blumberg sign, otherwise called rebound tenderness. Your doctor may also recommend an appendectomy. Lower abdominal pain and bloating sometimes occur together. Surprisingly, fever is present in only a minority of patients with amebic colitis. In the case of appendicitis, you may be given medications and fluids intravenously. Laboratory findings include a raised dialysate white cell count of >100 cells/mm3. Laboratory findings include a raised dialysate white cell count of >100 cells/mm3. Treat mild to moderate cases on an outpatient basis with ofloxacin (Floxin), 400 mg PO bid for 14 days, or levofloxacin (Levaquin), 500 mg PO qd for 14 days. Appendicitis: may be diffuse abdominal pain, but tenderness should be right lower quadrant. (BUDDHA), © No part of this blog should be reproduced without the prior permission of the owner. Removal, or application of a stimulus, which is pressure, causes the same response – pain – in the two instances. Additionally, the long-term sequelae of missing PID are significant and include infertility, tubo-ovarian abscess, perihepatitis, chronic pelvic pain, and ectopic pregnancy. This condition is known as shock. Apply a heating pad or hot water bottle to the tender area to relieve soreness. It may also aggravate your condition. Peptic ulcer: pain may be absent, possible presentations are painless gastrointestinal bleeding, severe anemia, bloating, nausea, early satiety. Skin rashes consistent with erythema nodosum, pyoderma gangrenosum, or dermatitis herpetiformis may be observed suggesting a diagnosis of IBD or celiac disease. May present with tachycardia, weight loss, fatigue, weakness, tremors, palpitations, atrial fibrillation and apathetic affect. Subphrenic abscesses are usually accompanied by chest findings with costal tenderness and pleural or pulmonary involvement, whereas subhepatic abscesses have more dominant signs of upper abdominal or subcostal involvement and fewer pulmonary changes. But really, this is a life-threatening situation for the mother especially when the fluid-filled sac containing the fetus bursts. In contrast, some patients may have large bowel dilatation without systemic toxicity. Abdominal tenderness and guarding are inconsistent findings and, when present, are rarely localized to the appendiceal area. are often associated with point tenderness. McBurney point is the most common type of abdominal tenderness and it usually is an indication of inflammation in the pelvis. Rectal examination can identify the presence of wall defects, such as a rectocele, rectal masses which may result in the clinical presentation of bloody diarrhea, or anal sphincter weakness arising as a consequence of pudendal neuropathy. Exit site and tunnel infection may be diagnosed by local signs and symptoms. Pneumonia: malaise, anorexia, confusion, fever may be absent, cough without significant production. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780702040641000427, URL: https://www.sciencedirect.com/science/article/pii/B0123868602005499, URL: https://www.sciencedirect.com/science/article/pii/B9780323401814001006, URL: https://www.sciencedirect.com/science/article/pii/B9780702045882000012, URL: https://www.sciencedirect.com/science/article/pii/B9781416043904000035, URL: https://www.sciencedirect.com/science/article/pii/B9780128036785003568, URL: https://www.sciencedirect.com/science/article/pii/B978145574801300076X, URL: https://www.sciencedirect.com/science/article/pii/B9780323040266500983, Infectious Diseases of the Fetus and Newborn (Seventh Edition), 2011, Infections associated with implanted medical devices, Antibiotic and Chemotherapy (Ninth Edition), Clinical Syndromes of Device-Associated Infections, Principles and Practice of Pediatric Infectious Diseases (Fifth Edition). A catheterized urine specimen will be required when a vaginal discharge or bleeding is present. Myocardial infarction: may be no chest pain but present with diaphoresis, dyspnea, epigastric distress, syncope, weakness, vomiting, confusion or upper extremity pain. Patients with large bowel dilatation may be ill-appearing with abdominal pain, distension and tenderness. Also hospitalize when there is severe illness with septicemia or other serious disease, high risk for poor compliance, failed follow-up, or failure after 48 hours of the outpatient therapy outlined later. The fluids will be introduced through a vein in your hand or arm. See detailed information below for a list of 59 causes of Abdominal tenderness, Symptom Checker, including diseases and drug side effect causes. White cells are usually predominantly neutrophils but may be dominated by other cell types when peritonitis is caused by unusual pathogens such as mycobacteria or fungi.228, Michael L. Steer, in Encyclopedia of Gastroenterology, 2004.