星期四, 9月 20, 2007

右下腹痛合併白血球高,要怎麼處理?

17歲年輕男生,星期一開始右下腹痛。No diarrhea, nausea, vomiting or fever。痛的位置很接近inguinal area,tender without peritoneal sign. plain film: much stool. LAB: WBC 13.5 k NEUT 85% ESR 5 UA: normal,當班的醫師給病人enema之後,下了診斷:
Abdominal pain, right lower quadrant
(Suspect)Diverticulosis of colon
(Suspect)Acute appendicitis
Functional G-I disturbance
接著開藥回家
Ponstan TID/PO 1T 3 days
Dimethicone TID/PO 1T 3 days
Cephalexin 500mg TID/PO 1CA 3 days
病人回家之後,還是持續疼痛,吃東西會不舒服會腹脹,no fever,no chills。母親帶去給家庭醫師看,建議還是要去找出原因,所以在星期三的晚上帶來急診,由小弟我診視…
的確是RLQ tender,位置很低,no peritoneal sign, no PSOAS sign, NO obturator sign, no Rovsing sign,LAB: wbc 9.8 k Neut 66.2 %, UA: normal, plain film: non-specific。接下來,該怎麼辦才好?