Abdominal Pain: The Daily PANCE Blueprint

Home Abdominal Pain: The Daily PANCE Blueprint

Abdominal Pain: The Daily PANCE Blueprint

A 24-year-old woman, gravida 2 para 1, at 30 weeks gestation, presents to the emergency department with sudden onset of severe, sharp, right lower quadrant abdominal pain that started 6 hours ago. She denies any vaginal bleeding or discharge. Her vital signs are stable, but she appears uncomfortable. On examination, there is marked tenderness in the right lower quadrant with rebound tenderness. Her white blood cell count is elevated. What is the most likely diagnosis?

A. Acute Appendicitis
B. Placental Abruption
C. Round Ligament Pain
D. Ectopic Pregnancy
E. Urinary Tract Infection

Answer and topic summary

The answer is A. Acute Appendicitis

The patient’s presentation of sudden onset, severe, sharp pain in the right lower quadrant with marked tenderness and rebound tenderness, along with an elevated white blood cell count, is characteristic of acute appendicitis. Pregnancy does not significantly decrease the risk of appendicitis, and it remains a common surgical emergency during pregnancy.

  • B. Placental Abruption: This condition typically presents with vaginal bleeding, abdominal pain, and uterine tenderness. The absence of vaginal bleeding and the specific nature of the pain make placental abruption less likely in this case.
  • C. Round Ligament Pain: While common during pregnancy, round ligament pain is typically a sharp, transient pain in the lower abdomen or groin and does not present with rebound tenderness or leukocytosis.
  • D. Ectopic Pregnancy: Ectopic pregnancy is a concern in early pregnancy but is unlikely at 30 weeks gestation. It usually presents with abdominal pain and vaginal bleeding, which are not described in this case.
  • E. Urinary Tract Infection: Although UTIs can cause abdominal pain and are common during pregnancy, the severe nature of the pain with rebound tenderness and the location of the pain are more indicative of appendicitis.
View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Diseases of the Small Intestine ⇒ Appendicitis

Also covered as part of the Emergency Medicine EOR, Family Medicine EOR, Pediatric EOR, and General Surgery EOR topic list