any medical doctors on here who may be able to ans this with explanation?
1.Case Presentation
A 68-year-old man presented to clinic with a 1-day history of constant, right lower quadrant pain. He denied fevers, chills, vomiting, diarrhea, melena, hematochezia, malaise, anorexia, cough, chest pain, headache, dysuria, and hematuria. His history was remarkable for bilateral inguinal hernia repairs 20 and 40 years ago, respectively, an episode of bacterial pneumonitis 3 months prior, and recent ultrasonic documentation of left atrial enlargement to 5.2 cm.
On physical examination, the patient was alert and oriented, appearing anicteric. He was afebrile, with an elevated systolic blood pressure of 188 mm Hg. His chest was clear to auscultation, and his heart rate was regular, with normal rhythm. His abdomen was soft to palpation and tender in the right lower quadrant, with voluntary guarding and questionable rebound. The abdomen was dull to percussion, except for the right lower quadrant where it was slightly tympanitic. No organomegaly or hernias were appreciated. Rectal examination was negative for occult blood.
Laboratory investigations disclosed the following: white cell count, 15,300 (neutrophils, 90%; basophils, 0%); hematocrit, 39.5%; platelets, 384,000 cells/mm3; serum sodium, 142 mmol/L; potassium, 4.1 mmol/L; chloride, 99 mmol/L; bicarbonate, 30 mEq/L; blood urea nitrogen, 13 mg/dL; creatinine, 0.9 mg/dL; glucose, 207 mg/dL; alkaline phosphatase, 80 U/L; prothrombin time, 13.3 seconds; and partial thromboplastin time, 25 seconds. Results of liver function tests and serum bilirubin were within normal limits.
Chest radiograph revealed a residual right upper lobe infiltrative, improved from the radiographic appearance at discharge 3 months previously. An abdominal radiograph showed a distended loop of bowel in the right lower quadrant, with the suggestion of pneumatosis.
Which of the following diagnoses should be considered based on the given clinical scenario?
A. Appendicitis
B. Colon carcinoma
C. Diverticulitis
Filed under: Potassium and Being Sick
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I don’t really love this question, to be honest. They seem to be going out of their way to say this patient doesn’t have a fever or chills. Therefore I assume they mean it is noninfectious, i.e. colon cancer. He does have an elevated white blood cell count, which can be due to the inflammation from a cancer, however, it can be seen with infection too. But without nausea, vomiting, chills, fever, I have to say colon cancer, because it is the right age group, and not appendicitis or diverticulitis, but those are not unreasonable guesses either.