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Mr. Cauthen's differential diagnosis is guided by the onset of acute widespread abdominal pain. The patient expresses discomfort in the middle area of the abdomen, demonstrating the likelihood of oedematous development in the colon in the event of colitis, inflammation of the appendix, and bulging sacs on the sigmoid colon lining in diverticulitis (Myers, Neighbors, & Tannehill-Jones, 2002). Pain and abrupt aggravation are symptoms of all three illnesses' early beginnings.
Anorexia, characterized by a loss of appetite, confirms the patient's chances of having severe diverticulitis, colitis, or acute appendicitis. Possibilities of the systemic roles are rejected, where Mr. Cauthen’s general appearance shows a healthy young man. His medical history does not reveal any chronicity. Other signs such as weight, temperature, and blood pressure among other readings are normal, eliminating the possibility of systemic issues that are commonly caused osmoregulatory organs.
The pathology of colitis and acute appendicitis is also reaffirmed by results of physical examination, where rebound tenderness test is positive. It signifies peritoneal irritation, where the Blumberg's sign of experiencing pain and tenderness on palpation is a classic indicative sign. It is a manifestation of the ulcerative colitis affecting the right lower quadrant of the abdominal region. Similarly, the discomfort elicited by profound and slow pressing and releasing of the right iliac fossa also confirms appendicitis. The symptom has immense clinical value, with Nema & Jain (2016) pointing out that its reliability has made it part of the MANTRELS scoring system in the diagnosis of appendicitis. The discomfort is explained by the fact that the stretching of the wall of the abdomen during palpation triggers the inflamed parietal peritoneum to produce pain confirmed by the abdominal guarding.
Normal Abdominal Findings
The rebound tenderness test and abdominal guarding would have been negative in healthy individuals, where gradual pressing of the right iliac fossa would not have caused any discomfort.
Myers, J. W., Neighbors, M., & Tannehill-Jones, R. (2002). Principles of pathophysiology and emergency medical care. Cengage Learning.
Nema, P., & Jain, A. K. (2016). A clinical comparative study of different scoring systems in acute appendicitis. International Surgery Journal, 3(1), 184-188.
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