Causes of right lower quadrant pain (right lower quadrant pain may not be appendicitis)
In recent years, with the popularization of medical knowledge, many common diseases can be recognized. For example, right lower quadrant pain, usually appendicitis. Therefore, everyone is accustomed to appendicitis, and it is generally not regarded as a major event.
However, today we are going to say that pain in the lower right quadrant may not be appendicitis!
When we get sick, we all subjectively hope that it is a minor illness. But follow the objective facts. There are always probabilities and unknowns in medicine, which is why doctors will never give you definite answers. This is very similar to appendicitis, and some people even know that they have a history of chronic appendicitis, but the doctor must do this and that check. Who can not be angry?
As a doctor, I strongly support doctors prescribing examinations. Even though there are very few doctors in the medical field who may prescribe a commission, it is necessary from the perspective of disease diagnosis and treatment. The final diagnosis of the disease requires not only the initial diagnosis, but also the differential diagnosis. In other words, a diagnosis without a differential diagnosis is untenable and cannot stand the test. For example, a person has something on their liver. As doctors, we cannot directly make a diagnosis of liver tumors, because we have to consider the possibility of hepatic hemangioma or liver cysts, which is a differential diagnosis. During the identification process, some auxiliary examinations are needed to help the doctor make a judgment.
Note that the word “judgment” is used here. Would it surprise you if doctors relied primarily on judgment in making a diagnosis? Yes, mostly judgment. Doctors make judgments based on their understanding of existing medical progress, their own experience, and relevant examination results, so there are so many treatments and even misdiagnoses.
For pain in the lower right abdomen, not only the general public will judge that it may be appendicitis, but doctors will also think of appendicitis first. In the medical world, fixed tenderness in the right lower quadrant and varying degrees of peritoneal swelling are the main signs of appendicitis. Especially when the abdominal pain is not fixed in the early stage of acute appendicitis, there is tenderness in the right lower abdomen. When appendix perforation is complicated by diffuse peritonitis, although abdominal tenderness is common, it is still most obvious in the right lower quadrant. Sometimes, to know the exact location of the tenderness, the doctor will perform several careful and comparative examinations of the entire abdomen.
A large number of data show that about 70% of appendicitis patients have metastatic right lower quadrant pain, rebound tenderness, muscle tension, positive psoas test, Colonic obturator internal muscle test is positive, but 30% of appendicitis patients have no obvious symptoms and signs, making diagnosis difficult. Another 100,000 people have an appendix in the left lower abdomen, which greatly increases the difficulty of diagnosis. To diagnose appendicitis, it is not enough to rely solely on the patient’s description and clinical symptoms. Therefore, the doctor will carry out some related examinations according to the situation, such as counting and classifying white blood cells, urinary tract, routine stool, X-ray thoracic and abdominal fluoroscopy, b-ultrasound examination, digital rectal examination, abdominal puncture, gynecological examination, etc. if necessary.
From a doctor’s point of view, if you find pain in the lower right abdomen, you may consider many diseases that may have the same symptoms. For example, gastroduodenal ulcer perforation, gynecological diseases, ureteral calculi, colon tumors, acute mesenteric lymphadenitis, right pneumonia, pleurisy, acute gastroenteritis, ileocecal tuberculosis, chronic inflammatory bowel disease and diverticulitis, etc.
The process of a doctor diagnosing a disease is like investigating a case. As a patient, you can actively provide clues to the doctor, but you cannot influence the doctor’s diagnosis. If you have doubts about the diagnosis, you can communicate or even transfer to another hospital for treatment. There is a saying that “faith leads to spirit”, which is the truth. Only when doctors and patients trust each other can we finally defeat disease.