Earlier this year, I received a phone call from a college-aged patient in the middle of exams who was complaining of abdominal pain. She'd experienced generalized abdominal pain earlier in the day but had tried to ignore it because she needed to study. Over the course of 8-10 hours, the pain had gotten worse and was more pronounced in her right lower quadrant. She was nauseated but had not vomited, and wasn't sure if she had a fever but felt warm.
There were enough clues in this student's history to interrupt her studying ("Are you serious?") and send her to the local emergency room for an evaluation.
Guessing that she had appendicitis, I talked to the ER doctor and it was decided to ultrasound her for suspected appendicitis. Unfortunately, they couldn't get a good look at her appendix, and the diagnosis was not confirmed.
The next radiographic test that's usually ordered when trying to diagnosis an inflamed appendix is a CT scan. Unfortunately, CT scans require radiation exposure (unlike an ultrasound) and there is continued concern about cumulative radiation exposure, especially among young patients. I had just read an article in the New England Journal of Medicine discussing the use of low dose CT vs. standard dose CT for diagnosing appendicitis.
The article showed that the low dose CT was not inferior to standard dose CT (if performed on non-obese patients) for diagnosing acute appendicitis. So, my young student underwent a low dose CT scan, which indeed confirmed her "hot appendix." She was scheduled for surgery early the next morning (by now it was almost dawn) and her appendix was removed laparoscopically. She was ready for discharge the following day.
Bottom line: less radiation, timely diagnosis, still able to wear a bikini as procedure used a scope vs. open incision and she was back at school in two days and finished her finals - thanks to the wonders of modern medicine!
(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at http://www.kidsdr.com.)
Diagnosing appendicitis: Quick action is key
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