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Clinical Evaluation of Patients with RLQ Abdominal Pain and Tenderness

Questionnaire

                                                                       

1. In all patients, whether adult or pediatric, male or female, presenting with right lower quadrant (RLQ) abdominal pain and tenderness, acute appendicitis should always be included in the diagnostic consideration.                      ___ YES         ___ NO.  If no, point out area(s) of disagreement

 

2. In the absence of urinary and bowel disturbance and absent vaginal discharge and no suspicion of pregnancy in the females, in all age groups with RLQ pain and tenderness less than 7 days in duration,

rank the following in terms of likelihood of acute appendicitis being present with Number 1 signifying the greatest likelihood and 5 being the lowest.

 

            Direct RLQ tenderness, No rebound, NO guarding                                  ___

            Direct RLQ tenderness, WITH rebound,  No guarding                             ___

            Direct RLQ tenderness, WITH rebound,  WITH guarding                         ___

            Direct RLQ tenderness, NO rebound,  WITH guarding                             ___

            Rebound RLQ tenderness, NO direct tenderness, NO guarding            ___

 

3. Do you routinely do/request for the following examinations/maneuvers after eliciting the presence of RLQ tenderness?

                                                                                    YES    NO      If NO, Indication or why?

            3.1 Elicit cough sign                                     ___     __        ___________________

            3.2 Elicit Rovsing sign                                  ___     __        ___________________    

            3.3 Elicit Psoas sign                                     ___     __        ___________________

            3.4 Elicit Obturator sign                                ___     __        ___________________

            3.5 Do rectal exam                                       ___     __        ___________________

            3.6 Do internal exam in the female patient ___     __        ___________________

 

4. Do you routinely do/request for the following examinations/maneuvers after eliciting the presence of RLQ tenderness?

                                                                                                            YES    NO      If NO, Indication or why?

            4.1 CBC                                                                                 ___     __        __________________

            4.2 Urinalysis                                                                         ___     __        __________________

            4.3 Ultrasound of the lower abdomen or pelvis                 ___     __        __________________

            4.4 Observation - monitoring the abdominal findings       ___     __        __________________

 

5. What do you think is the most reliable set of signs and symptoms (observation included  but laboratory exams excluded)  that carries a 99% accuracy rate in diagnosing a patient with RLQ pain and tenderness of less than 7 day duration to have acute appendicitis? (Choose one or write one)

 

            5.1 Definite localized direct RLQ tenderness

                        no urinary disturbance

                        no bowel movement disturbance

                        not pregnant

                        no vaginal discharge

                        no other symptom or sign to point to other medical condition

            5.2 Definite localized direct RLQ tenderness with guarding

                        no urinary disturbance

                        no bowel movement disturbance

                        not pregnant

                        no vaginal discharge

                        no other symptom or sign to point to other medical condition

            5.3 Others (pls. specify):