Question on sisters visit to ER

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Hello. I am starting the nursing program in January, taking other classes now to prepare. I have a question about my sister's trip to the ER. She went in Saturday due to high temperature and severe stomach pains. The doctor ordered a urine test, had to send it to the lab because he couldn't see anything in it, and told her she had a UTI. She stayed at my parents house that night because she was in so much pain. Sunday morning, pain was worse. My father took her back to the ER, they did a sonagram and found out her appendicts (Sorry if not spelled right) needed to come out right now. They had to do an incision due to the fact the infection was so bad, the doctor said it was the worst infection he had ever seen. She will probably go home Tuesday or Wednesday, but is still in alot of pain.

My question would be, was the initial ER doctor probably in a hurry when he first saw her, or is it hard to diagnose appendicitis?

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Interesting. Misdiagnosis is 33% for non pregnant women of childbearing age, and one of the leading misdiagnosis is urinary tract infection.

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Don't know about the US, but in the UK we don't diagnose a UTI without Nitrites, Leucocytes and Protein in the urine, without that, its not a UTI. As for appendicitis, well, it can present oddly in the early stages, but just be happy it didn't rupture or she'd be in next week. Appendicitis is difficult to diagnose, often they are sent home and asked to come back if the pain worsens.

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Hi there!

When someone comes into the ED with a complaint we generally try to do the least invasive and cost effective tests first so that we can rule out something simple without a huge cost to the patient, use of resources in our ED and taking a large amount of time. In your sisters case (I assume) a Urinalysis was done and a UTI was indicated and she was treated for that. At that point unless there was further indication of infection somewhere else we would stop there. As someone said Appendicitis can present in different ways. Many times it isnt easy to diagnose - and can be misdiagnosed especially if there is another infection present, even with a nasty appendicitis like your sister's.

I am sorry she had to go through so much pain and her appendicitis was missed at the ED. Unfortunately, medicine is just not always an exact science.

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I think we are just glad it was caught in time!

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I think we are just glad it was caught in time!

Me too! Hope she is feeling better today! :o

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

I don't work in the ER, but have floated over there a few times. It seems like the first train of thought in an abd pain pt is r/o appendicitis at our hospital. Our docs seem to take abd pain pretty seriously, as they should. People are not usually sent home until it's pretty clear the problem is NOT appendix. UTIs don't generally cause high fever and severe abdominal pain. I took my husband to the closest little 4 bed ER one morning with abd pain and they had him in the OR within an hour. All they needed was a WBC of 20, temp over 100, obvious guarding and rebound pain. No ultrasound needed, just some good old logical thinking. They did r/o obstruction with a KUB. Sure enough, it had already burst - a few more hours and he wouldn't be here today. Good thing they didn't diagnose him with a UTI and send him home. There are way too many examples of needless death due to appendicitis being misdiagnosed.

sydylo - I'm really glad your Dad persisted and took your sister back - and I'm glad she's doing well!

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Specializes in ER.
I don't work in the ER, but have floated over there a few times. It seems like the first train of thought in an abd pain pt is r/o appendicitis at our hospital. Our docs seem to take abd pain pretty seriously, as they should. People are not usually sent home until it's pretty clear the problem is NOT appendix. UTIs don't generally cause high fever and severe abdominal pain. I took my husband to the closest little 4 bed ER one morning with abd pain and they had him in the OR within an hour. All they needed was a WBC of 20, temp over 100, obvious guarding and rebound pain. No ultrasound needed, just some good old logical thinking. They did r/o obstruction with a KUB. Sure enough, it had already burst - a few more hours and he wouldn't be here today. Good thing they didn't diagnose him with a UTI and send him home. There are way too many examples of needless death due to appendicitis being misdiagnosed.

sydylo - I'm really glad your Dad persisted and took your sister back - and I'm glad she's doing well!

pricklypear - I'm glad things worked out well for your hubby - I must say though, I'm glad I didn't go to that ER when I was sure I had appendicitis... I had all the same symptoms he had... the docs were all sure I had appendicitis. They were prepping the OR and working up my admission papers for appendicitis as I went to last minute CT scan. THANK GOD THEY DID THAT LAST MINUTE CT!!!! Turns out my appendix was fine - I had a raging kidney infection that landed me on close observation for 5 days, on IV abx around the clock and neuro workup (from the headaches I got from the backup of toxins in my body that my kidneys couldn't take care of). I'm just glad I didn't have an incision to worry about too! IMO, a doctor should NEVER do surgery without having seen on some radiological study whether CT scan, Ultrasound, etc. that the cause of the pain is surgical. I would have sued - and won - if I had gone to the OR without the CT scan. Other things can cause belly pain - and not all of them need surgery!!

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Appendicitis can be misdiagnosed as UTI - it depends on how the symptoms present. We do not do abdominal ultrasounds on every pt - especially if the urinalysis comes back positive and there is no other evidence of appendicitis -which I dont have much to go on as far as that is concerned. There may have been additional labwork however the article that was posted above states "No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases".

A kidney infection or even PID can cause elevated WBCs, high fever and severe abd. pain. Of course, I dont have the labs or assessment info to evaluate what the MD was thinking. In our ED we always assess for rebound tenderness - although this is absent in many depending on the location of the appendix in the abdominal cavity. And any time symptoms increase in severity the pt should return to the ED.

I think part of the problem lies in that many EDs do unnecessary testing that costs the pt. a great deal of money when the diagnosis could have been made based on more inexpensive diagnostic criteria.

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Specializes in PeriOp, ICU, PICU, NICU.

Wow, I am so glad she was treated in time. :)

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.
pricklypear - I'm glad things worked out well for your hubby - I must say though, I'm glad I didn't go to that ER when I was sure I had appendicitis... I had all the same symptoms he had... the docs were all sure I had appendicitis. They were prepping the OR and working up my admission papers for appendicitis as I went to last minute CT scan. THANK GOD THEY DID THAT LAST MINUTE CT!!!! Turns out my appendix was fine - I had a raging kidney infection that landed me on close observation for 5 days, on IV abx around the clock and neuro workup (from the headaches I got from the backup of toxins in my body that my kidneys couldn't take care of). I'm just glad I didn't have an incision to worry about too! IMO, a doctor should NEVER do surgery without having seen on some radiological study whether CT scan, Ultrasound, etc. that the cause of the pain is surgical. I would have sued - and won - if I had gone to the OR without the CT scan. Other things can cause belly pain - and not all of them need surgery!!

I totally see your point, what a close call for you! The ER doc did check for flank pain on my husband. The surgeon told us they may not have seen anything on ultrasound, the appendix was tucked up behind the colon and encapsulated when he got in there. No CT at that little hospital. I agree with you about being sure - make sure it's NOT surgical before sending someone home! Kidney infections suck - I've had one in my life, and don't want to repeat it!!

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