Jennifer is a 24 year old female who presents to the Emergency Department with RIF pain.
The pain was initially peri-umbilical, but in the last 6 hours has localized to her RIF. She has a decreased appetite and vomited undigested food once. She does report some urinary frequency in the last 24 hours. Her LMP was 10 days ago. She has no previous medical or surgical history, is only on the oral contraceptive pill and has no drug allergies.
On examination she is tender to palpation in her RIF, but her abdomen is otherwise soft throughout.
Her blood tests reveal a leukocytosis with a WCC of 12. CRP is also raised at 46. Urine microscopy is normal and a pregnanacy test is negative.
What is your differential diagnosis?
What clinical signs indicate that a patient with appendicitis may have perforated their appendix?
What are the clinical signs you can elucidate when examining a patient with appendicitis?
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