NMS. Surgery

385

Chapter 18 ♦ Acute Abdominal Surgical Emergencies

McBurney point Anterior superior iliac spine Cecum Appendix

Umbilicus

Left lower quadrant Rovsing sign elicited when left lower quadrant is palpated

Right lowe quadrant r

Figure 18-2: When the appendix is inflamed, tenderness can be noted in the right lower quadrant at McBurney point, which is between the umbilicus and the anterior superior iliac spine. (From Honan L: Focus on Adult Health, 2nd ed. Wolters Kluwer Health, 2018, Fig. 24-2).

Diagnostic Testing

I. Laboratory evaluation A. Complete blood count with differential

1. Can reveal anemia or dehydration and suggest infection. 2. Normal or low white blood cell count can be seen with infection in immunosuppressed, elderly, and diabetic patients. B. Serum electrolytes: Can detect abnormalities (e.g., acute renal injury, acidosis, and alkalosis). C. Elevated lactate levels 1. Can indicate under-resuscitation, ischemia, or necrotic tissue. 2. Elevated in liver failure. D. Urinalysis: Can identify UTI or kidney stone. E. Amylase and lipase: Elevations suggest pancreatitis; amylase is less specific. F. Coagulation studies: Essential for patients suspected of needing procedural intervention. G. Beta-human chorionic gonadotropin: Indicated for women of childbearing potential.