Jon wilcox wrote in reference to PR, temp and hosp docs:
JB>Not to mention the vaginal examination... as soon as you mention "young
JB>woman... appendix ... not clinically gynae pain". We get the usual
JB>surgical retort (well quite often) how can you be SURE it is not gynae.
JB>Have you done a PV? Have you done a chlamydia, and if not has she ever
JB>had one? What do you MEAN it's not gynae pain.. etc. etc.
JB>Indeed I had a young 22 year old woman last week who developed pain the
JB>same day, clinically had appendicitis (rebound, peritonism). She didn't
JB>need a rectal or VE and her temperature was normal. Histology came back
JB>today as inflamed appendix. Understandably the surgeons are embarrassed
JB>having to do a VE when it might (rarely) be needed, but one has to
JB>respect the patient and the clinical relevance of the procedure. The
JB>giveaway for this young woman was her unexpected excruciation upon
JB>hopping on her right leg! Hopper's Sign perhaps.
I think this is already described as the "foot stamping sign"
and is said to be especially useful in middle and last
trimester pregnancies with appendicitis.
______________________________________________________________
Dr. David Jobson
The Surgery, Main St Surgery Tel +44 (0)1728 830526
Leiston Surgery Fax 832029
Suffolk Home Tel 831100
IP16 4JG email [log in to unmask]
* SLMR 2.1a *
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