Sequence of Pain of Acute Appendicitis

Ms. F, 48 years old, has been admitted to the hospital with severe abdominal pain. Earlier that day she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly improved and the pain seemed to subside somewhat. Later that night, severe, steady abdominal pain developed, with vomiting. A friend took her to the hospital, where examination demonstrated lower right quadrant tenderness and mild abdominal rigidity. Fever and leukocytosis indicated infection. A diagnosis of acute appendicitis, with possible perforation, was indicated, with immediate surgery.
Discussion Questions
Why is the sequence of pain (location and type of pain) significant in the diagnosis of acute appendicitis? Describe the rational for each type of pain. Does this sequence confirm the diagnosis?
Using the pathophysiology, describe the reason for:
the pain subsiding and then recurring.
leukocytosis and fever.
abdominal rigidity.
Ms. T, age 28 years, has noticed urgency, frequency, and dysuria recently, as well as an unusual odor to the urine. Urinalysis indicated a heavy concentration of Escherichia coli in the urine, some pus, and WBCs. Ms. T was prescribed antibiotics, which she took for the first few days. This seemed to give her relief, but she then stopped taking the medication. Within a few days, the symptoms returned, but she decided to “just live with it.”
Discussion Questions
Explain why women are predisposed to cystitis.
What preventive measures are important in reducing recurrence?
Discuss other signs and symptoms that may indicate cystitis.
What potential problems may she experience if she does not adhere to the treatment prescribed?