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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 6948
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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My girlfriend has been to the local GP with stomach pains 2

Resolved Question:

My girlfriend has been to the local GP with stomach pains 2 weeks ago. The nurse said she suspected it was appendicitus, but made an appointment to see the doctor a week later, in case it was kidney stones. At the first doctors appointment, the doctor said it was either appendicitus, or kidney stones, and took blood for a test to confirm this. Whilst waiting for the results, she was prescribed a course of Trimethoprim. Today the doctor has said that the results show she does not have kidney stones, and that it is probably appendicitus. He has said that if she has any more pains, she should go straight to hospital. I'm concerned that if it is appendicitus, and the doctor suspects it is, why she hasn't been referred straight for treatment. Why does she have to wait until she is in pain again before then being treated as an emergency.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Uzair replied 2 years ago.
Dr Uzair :

Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Dr Uzair :

There is no blood test to show kidney stones. I am uncertain why the doctor has adopted this mode of action.

Dr Uzair :

Was she clinically examined for tenderness in her right lower quadrant?

Customer:

Yes

Dr Uzair :

Okay, did she have loss of appetite? Nausea?

Customer:

nausea

Customer:

only loss of appetite for one day

Dr Uzair :

Okay, was the pain sharp stabbing or dull aching?

Customer:

both

Customer:

constantly dull, and occasionally sharp

Dr Uzair :

Okay, is she in the middle of her cycle and has she had any menstrual irregularities?

Customer:

yes she is in the middle, no irregularities

Dr Uzair :

Okay, is she with you at the moment?

Customer:

no, but I can speak to her now

Customer:

she is travelling back from her appointment at the doctors

Dr Uzair :

Okay, if she were with you it would have been easier to do a test, ask her if she has any pain in the right lower quadrant if she stands on her toes and then back on her heel with a jerk.

Customer:

ok, she's on the bus at the moment, but I will ask her to try when she returns home

Customer:

if she does have pain, is that a sign of appendicitus?

Dr Uzair :

Okay, if there is pain with that then it means there is peritoneal inflammation.

Customer:

ok

Dr Uzair :

The best thing to do as a test will be to put two finger pressure on the right lower quadrant half way between the anterior bony prominence of her hip bone and the umbilicus and then release it with a jerk.

Dr Uzair :

If the release induces more pain then that means there is peritoneal inflammation which is a significant sign of an inflamed appendix.

Customer:

ok

Dr Uzair :

None the less, these tests are for physicians and require experience for judgement. The best thing to do will be to get an ultrasound done.

Dr Uzair :

The ultrasound will rule out kidney stones as well as ovarian cysts (mid cycle pain).

Dr Uzair :

Sometimes, experienced sonologists can see inflammation of the appendix as well.

Dr Uzair :

Your physician should have been more proactive in his/her approach.

Dr Uzair :

And if appendicitis was suspected, Trimethoprim is in no way a good choice for an antibiotic.

Customer:

that's what concerns me, the answer was to simply wait for more pain, then go to ho#ospital

Dr Uzair :

S/he should have at least started Metronidazole (for anaerobic coverage) and a cephalosporin or Co-Amoxiclav (for gram positive and negative coverage).

Dr Uzair :

There is a scoring system we use to judge the severity of appendicitis.

Customer:

ok I've spoke to her, she has no pain right now if she stands on her toes and drops to her heel suddenly

Dr Uzair :

If the score shows a mild inflammation then a double antibiotic cover and nil per oral for 2 days and a soft diet there after for a week is recommended along with good painkillers before sending the patient home.

Dr Uzair :

For moderate appendicitis patient is given a choice of either surgery or conservative treatment with medication.

Dr Uzair :

For severe cases, surgery is a must.

Dr Uzair :

That's good news.

Customer:

ok

Dr Uzair :

For the future, if she has any pain, that mimics appendicitis, get an ultrasound done, if the physician is unsure.

Dr Uzair :

And again, a blood test will never show a kidney stone, only an erect x ray with empty bowels or an ultrasound or a CT scan will show stones in the kidneys or the ureters.

Customer:

To be honest, if she has pain tonight again like normal, I would take her to the hospital. I wouldn't want to make an appointment at the doctors again, it takes a week.

Dr Uzair :

That is a better idea.

Dr Uzair :

Nowadays, appendicitis is not a big deal. But, if the diagnosis is delayed then it takes us back a 100 years when appendicitis was a big deal.

Dr Uzair :

Do you have any more queries for me?

Customer:

no, thankyou for your time

Dr Uzair :

It was a pleasure, let me know if you have any future concerns.

Customer:

Thankyou. Have a good day.

Dr Uzair :

Please do leave a positive rating for me by clicking on the stars below.

Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 6948
Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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