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19. A 27-year-old primigravid woman at 29 weeks' gestation comes to the emergency department because of a 24-hour history of increasingly severe right-sided abdominal pain and no appetite. She has vomited twice over the past 4 hours. She has not had vaginal bleeding. Her temperature is 38.2 C (100.8 F). Examination shows exquisite tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel sounds are absent. The fetal heart rate is 144/min. Laboratory studies show:

Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf

Which of the following is the most likely diagnosis?

A) Abruptio placentae
B) Appendicitis
C) Cholelithiasis
D) Colitis
E) Pyelonephritis

B) Appendicitis

then why no peritoneal sign? I choose E. also there is tenderness over fundus.

???????

??? anyone

her labs point more towards infection..not abruptio

I WILL GO WITH E

what about her absent bowl sounds...and vomiting....those point towards b.

there are much more points for Appendicitis than there is for, pyelonephritis. Look at Labs, esp Urine WBC's

Why urine WBC goes for appendicitis?