A 17-year-old male presents to the emergency department with a 24-hour history of abdominal pain that initially started around the umbilicus and has now localized to the right lower quadrant. He rates the pain as 7/10 and describes it as constant. The patient also reports a low-grade fever and nausea without vomiting. On examination, there is tenderness at McBurney's point. Based on the clinical presentation, what is the most appropriate next step in management?
Administer broad-spectrum antibiotics and reassess in 12 hours.
Obtain a computed tomography (CT) scan of the abdomen.
Order laboratory studies, including a complete blood count, and discharge with outpatient follow-up.
Immediately prepare the patient for emergency surgery without further imaging.
The clinical presentation is suggestive of appendicitis, especially with the migration of pain to the right lower quadrant and localized tenderness at McBurney's point. The most appropriate next step in management is to obtain a computed tomography (CT) of the abdomen, which can help confirm the diagnosis of appendicitis. Once confirmed, this typically leads to surgical consultation for an appendectomy. Lab studies can aid in the diagnosis but are not definitive; while emergency surgery is necessary, it follows confirmation by imaging in equivocal cases, and antibiotics alone would not be the appropriate next step without surgical evaluation.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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