Differential Diagnosis
- Single most likely diagnosis
- Appendicitis: This is the most likely diagnosis given the patient's presentation of sharp, right-sided abdominal pain, nausea, vomiting, and abdominal tenderness, particularly in the right lower quadrant. The presence of guarding, rebound tenderness, and decreased bowel sounds further supports this diagnosis. The patient's recent cesarean delivery and subsequent increased intra-abdominal pressure may have contributed to the development of appendicitis.
- Other Likely diagnoses
- Wound infection or abscess: Although the surgical incision has minimal serosanguineous discharge, the patient's fever, elevated leukocyte count, and abdominal tenderness could be indicative of a wound infection or abscess. However, the absence of fluctuance or mass at the surgical site makes this diagnosis less likely.
- Pelvic thrombophlebitis: This condition can occur after childbirth, particularly after cesarean delivery, and may present with abdominal pain, fever, and elevated leukocyte count. However, the patient's sharp, right-sided abdominal pain and localized tenderness make this diagnosis less likely.
- Ovarian torsion: This is a possible diagnosis given the patient's sharp, right-sided abdominal pain and recent cesarean delivery. However, the absence of a palpable mass or purulent discharge makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ruptured ectopic pregnancy: Although the patient recently underwent a cesarean delivery, a ruptured ectopic pregnancy is a life-threatening condition that must be considered, particularly if the patient's symptoms worsen or if there is evidence of hemodynamic instability.
- Uterine rupture or dehiscence: This is a rare but potentially life-threatening complication of cesarean delivery, particularly if the patient's symptoms worsen or if there is evidence of hemodynamic instability.
- Pulmonary embolism: This is a possible diagnosis given the patient's recent cesarean delivery and subsequent increased risk of venous thromboembolism. However, the patient's symptoms and physical examination findings are not typical of pulmonary embolism.
- Rare diagnoses
- Hepatitis or liver abscess: These conditions can present with abdominal pain, fever, and elevated leukocyte count, but are less likely given the patient's recent cesarean delivery and lack of other symptoms such as jaundice or liver dysfunction.
- Right-sided diverticulitis: This is a rare condition that can present with abdominal pain, fever, and elevated leukocyte count, but is less likely given the patient's age and lack of other symptoms such as changes in bowel habits or gastrointestinal bleeding.