An 18 year old patient presents with acute abdominal pain, vomiting and on clinical examination loin tenderness is present. History of pyrexia is absent. The diagnosis is
(A) Acute testicular torsion# TESTICULAR TORSION Usually presents with sudden, severe, testicular pain (in groin and lower abdomen) and tenderness. There is often associated nausea and vomiting. Testis may be higher than its normal position. Mild pyrexia and redness of overlying area may be found. Presentation of acute appendicitis includes abdominal pain, nausea, vomiting, and fever. Appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. Leads to the localization of the pain to the right lower quadrant. Classic migration of pain may not be seen in children under three years. Pain can be elicited through signs and can be severe. Signs include localized findings in the right iliac fossa. Abdominal wall becomes very sensitive to gentle pressure (palpation). There is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). If appendix is retrocecal (localized behind the cecum), even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix). This is because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. Digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point).> Acute pyelonephritis develop rapidly over a few hours or a day & it can cause high fever, pain on passing urine, and abdominal pain that radiates along the flank towards the back. There is often associated vomiting.> Chronic pyelonephritis causes persistent flank or abdominal pain, signs of infection (fever, unintentional weight loss, malaise, decreased appetite), lower urinary tract symptoms and blood in the urine.> Diverticulitis symptoms may include: Tenderness, cramps, or pain in the abdomen (usually in the lower left side but may occur on the right) that is sometimes worse with movement. Fever and chills. Bloated feeling, abdominal swelling, or gas. Diarrhea or constipation. Nausea and sometimes vomiting. Loss of appetite.
Acute testicular torsion
Acute appendicitis
Acute pyelonephritis
Acute diverticulitis
Miscellaneous