Lesson 1Laboratory tests: CBC, CRP, basic metabolic panel, pregnancy test in females, urinalysis and interpretationDetails key laboratory tests in suspected appendicitis, including CBC, CRP, metabolic panel, pregnancy testing, and urinalysis, with emphasis on result patterns, diagnostic value, limitations, and integration with clinical findings for better patient care.
CBC patterns and leukocytosis thresholdsCRP trends and prognostic implicationsElectrolytes, renal function, and dehydrationPregnancy testing and ectopic exclusionUrinalysis to distinguish urinary pathologyCombining lab data with clinical assessmentLesson 2Targeted physical examination: inspection, auscultation, palpation, percussion, rebound, Rovsing's, psoas and obturator signsCovers a stepwise abdominal exam for suspected appendicitis, including inspection, auscultation, palpation, percussion, and specific maneuvers such as Rovsing, psoas, and obturator tests, with technique tips and interpretation suitable for local practice.
Safe abdominal inspection and auscultationLight and deep palpation techniquesEliciting rebound and guardingPerforming Rovsing’s sign correctlyPsoas and obturator tests and meaningExam pitfalls in obese or pregnant patientsLesson 3Common and important differential diagnoses and discriminating features: mesenteric adenitis, ovarian torsion/ruptured cyst, gastroenteritis, ectopic pregnancy, diverticulitis, urinary tract causesAnalyzes common differential diagnoses for right lower quadrant pain, including mesenteric adenitis, gynecologic, urinary, and colonic causes, highlighting discriminating history, exam, and imaging features to avoid misdiagnosis in resource-limited areas.
Mesenteric adenitis versus appendicitisOvarian torsion and ruptured ovarian cystEctopic pregnancy and early pregnancy lossGastroenteritis and colitis mimicsDiverticulitis and colonic pathologyUrinary tract and renal colic featuresLesson 4Systemic exam priorities: vital signs interpretation, sepsis screen, genitourinary and pelvic exam considerationsFocuses on systemic assessment to detect sepsis and alternative sources, emphasizing vital sign interpretation, early warning scores, fluid status, and targeted genitourinary and pelvic exams, including chaperone and consent considerations in Gambian context.
Interpreting vital signs and shock patternsScreening for sepsis and organ dysfunctionAssessing volume status at the bedsideFocused genitourinary examination stepsPelvic exam indications and techniqueInfection control, consent, and chaperonesLesson 5Focused history-taking for acute abdominal pain (onset, character, migration, associated symptoms, menstrual/GI history)Provides a structured approach to history-taking in acute abdominal pain, emphasizing onset, character, migration, associated gastrointestinal and urinary symptoms, menstrual and sexual history, red flags, and prior abdominal surgery for effective diagnosis.
Character, onset, and pain migrationAssociated GI and systemic symptomsUrinary and renal symptom screeningMenstrual, sexual, and obstetric historyMedication, comorbidity, and surgery historyRed flag features requiring urgent actionLesson 6Clinical decision-making for borderline or atypical presentations and when to consult surgery or senior reviewAddresses decision-making in borderline or atypical appendicitis, including equivocal scores or imaging, use of observation units, repeat exams, shared decision-making, and clear thresholds for surgical or senior consultation in busy wards.
Recognizing atypical symptom patternsManaging equivocal lab or imaging resultsUse of observation and serial examinationsDocumentation and safety-netting adviceWhen to involve senior or surgical reviewCommunicating uncertainty with patientsLesson 7Diagnostic pathways and scoring systems: Alvarado score, Appendicitis Inflammatory Response (AIR) score, when to use observation vs imagingExplores structured diagnostic pathways using Alvarado and AIR scores, clarifying cutoffs, risk stratification, and how to choose observation, serial exams, or imaging to minimize missed appendicitis and unnecessary surgery in local hospitals.
Components of the Alvarado scoreAIR score variables and weightingRisk categories and score cutoffsWhen to observe with serial examsWhen to proceed directly to imagingPathways for pediatric and elderly patientsLesson 8Imaging choices and interpretation: ultrasound findings in appendicitis, graded-compression technique, CT abdomen pelvis with IV contrast indications and key findingsReviews imaging options for suspected appendicitis, emphasizing graded-compression ultrasound, CT abdomen pelvis with IV contrast, and selective MRI, with indications, key diagnostic signs, limitations, and radiation and contrast safety issues for Gambia.
Ultrasound graded-compression techniqueSonographic signs of acute appendicitisCT indications and contrast protocolsCT findings and alternative diagnosesImaging in children and pregnancyCommunicating results with radiology
