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McMurphy’s Point*4

History:

A 46 year old male without PMH presents to the ED for 3 days of slowly progressive constant right mid abdominal pain. Pain is worse with movement or deep breathing. He denies N/V, fever, diarrhea or other complaints.

Exam:

Abdomen: Soft. There is right sided tenderness at McMurphy’s point (midway between McBurney’s and Murphy’s) No guarding or rebound.  He has right sided CVA tenderness.

Initial Concerns: gallstone, kidney stone, appendicitis

Testing:

  • WBC = 8.2 with 71% PMN
  • AST/ALT = 83/70
  • UA negative
  • CT image

perirenal-appendicitis

 

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this topic? 

 

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ANSWERS:

  1. What does the case image show?  The image shows acute appendicitis.  The appendix is located in an ectopic locations just below the tip of the liver and lateral to the right kidney coming upwards from the colon.  Ectopic locations can cause atypical symptoms.
  2. What should you do next?  IV antibiotics, NPO, consult surgery
  3. Want a 1-minute consult/tutorial on this topic?  See yellow area from sample page below.

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APPENDICITIS from QUICK ESSENTIALS: Emergency Medicine 1-minute consult pocketbook

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