Another one of those shall I go to A&E threads...

[QueenArseClangers]

DD who's 11 has had tummy ache since Monday eve. Thought it was period pains (she has horrible ones bless her) but she was sick Tues morning twice.
Thought it was a bug so kept her off 48 hrs etc. No diarrhoea or any other sickness.
Last night her pain increased, it's near belly button and radiates to right lower side Abdomen tender upon pressure and she felt quite warm.
She's been off food for days which is not like her at all and not had a poo for 2 days.

So, rang 111 last night. Sent her and DH to OOH where GP palpates abdo, tests urine and does obs.

Diagnoses bowel pain and gives her Buscopan and says to give it 24/48 hrs to let it work.

She's still sore this morning and not at school.

Actually, reading what I've written, I've come to the decision that I am going to take her today. Very worried it's appendicitis.

Just to say for general info really, I had appendicitis earlier this year. It was a bout of severe pain that lasted about 3 hours then went off. No vomiting or diarrhea. I only went to the doctor's two days later when I had a temperature, fluey aches and my dog jumping on my lap was agonisingly, but briefly, painful. By that point I was developing sepsis. Not every case of every serious illness is textbook.

Frankly, there's a temperature so something's going on. If you can't get a GP appt, A&E is appropriate in this case.

It is typical of appendicitis to be vague & central for a while, sometime a few days, before localising to the bottom right hand corner of the tummy.

GP is the best person to see her - they will be able to compare the findings from the previous appointment which will also be helpful. They will arrange admission to see welshweasel or similar.

Take her there if you can't get through on the phone.

Or, you could go to the GP surgery (hopefully OP is already there) and be seen by a GP/nurse practitioner and tell them that you are concerned that it could be appendicitis. It's a very hard diagnosis to make, particularly in children, so if there is any doubt they will usually refer you to hospital for assessment (and yes, in some hospitals, children will be seen in A&E even if they have been referred by the GP but this is usually in the children's area, by paeds doctors - I don't know of a hospital where this would be the case for adults). Often we send patients home and tell them to come back if the pain is getting worse/not improving/other symptoms develop. We want you to come back so that we can see you again. It doesn't mean that we are fobbing you off and want you to go to A&E instead.

You posted at 8.42am. At that time the phones are often ringing constantly. I hope you've taken her to the GP. These a and E threads are getting a bit silly. It's Friday morning, there will be a GP in surgery who will undoubtedly see her as the last thing they want is you trotting off to a and E.

I'd go to a and e personally. Severe abdominal pain is on the list of things on the 'where should I go' for a&e posters parked all over. And I say this as someone who took a family member to a walk in clinic over Christmas with abdominal pain radiating right, who was promptly dosed up on painkillers and sent across to accident and emergency to be seen, under the instruction that as appendicitis is so difficult to diagnose a surgeon needed to be seen (apparently even the blood tests aren't conclusive and they never completely know one way or another until they're in having a rummage).

sunshine yes appendicitis is a difficult diagnosis to make, even for a consultant surgeon. How many surgeons work in A&E? None! You don't send someone to A&E to see a surgeon.

Welshweasal - none. But the a&he consultant called the SA ward and one was down within ten minutes. Imagine that! A surgeon in a hospital. Shock horror.

So, first patient of the day sees GP with a short history of abdominal pain. Gets sent to see me. I see her, examine her, take some bloods, dip her urine, organise an ultrasound scan, explain that I'm 99% sure she doesn't have appendicitis and send her home with some painkillers and open access to the unit for the next 48 hours in case she gets worse. Total time from seeing GP to getting discharged is 3 hours. Patient delighted with service. Next patient comes to A&E with same symptoms, waits for 4 hours. Sees a junior doctor who has never worked in surgery. Gets told they probably have appendicitis after waiting for their blood results. Gets sent to see me. I examine them and look at their blood results and send them home. Patient furious as they've been waiting in hospital all day and the A&E doctor told them they needed an operation and now I'm telling them they don't and don't we have a clue what we are talking about. Patient makes a complaint. Welcome to my world.

Some people seem to be appendicitis experts. In my (very recent) experience it doesn't have to be "excruciating" nor "doubled over in pain" - yes it might be or there may be moments but not always and not always consistently either. People have very different pain thresholds. Appendicitis is notoriously hard to diagnose apparently - something I've heard numerous times over the past few weeks. But it's classed as an emergency as if left untreated can be life threatening.
IME the big tell tale for me that it wasn't just "needing a big poo" or a bug was I couldn't lift my right leg. Left leg absolutely fine, couldn't even get my right sock on or cross my leg over without physically lifting it. I went to A&E...on Christmas Eve of all days and yes there was waiting around and tests before I was referred to SAU. I'd already seen a GP out of ours the previous day and he had prescribed Movicol - which wouldn't have solved my problem after all.

sunshine so you agree the patient didn't need to be seen in A&E at all? If the WIC had been doing their job properly they would have gone straight from WIC to a surgical assessment ward, thereby cutting out an unnecessary examination by an A&E consultant (who quite frankly has better things to do) and freeing up a trolley in A&E to be used by someone who actually needs to be there!

.

No. I don't. We specifically asked about an appointment to go straight to the surgeon and were told the only way to see them that day was via a&e.

In my area for children you do send to paediatric A&E and then paediatric surgeons are bleeped and attend to review after the blood test results are back. The blood tests are ordered by a junior doctor. Different for area and adults/paediatric.

Sorry, not having a go at you. Just pointing out that the WIC were being rubbish! You didn't gain anything from going to A&E that you couldn't have got going straight to surgery. Not your fault that this wasn't an option made available to you...

Yes agree in some areas kids go to A&E. Just trying (and failing) to do some education for the wider population. I'll bugger off to work now

Problem for my son was that blood tests didn't show up anything either. Apparently that's also quite common and one of the reasons diagnosis is hard?

I think this question of A&E vs GP appointment for direct access to surgical/ paeds ward depends on your local hospital and how it works there. I work in a children's hospital and have been referred via GP with my own DD. All GP referrals are seen in A&E (in a seperate area, but you initially book in and sit in the same waiting area as everyone else and see the same triage nurse before taken round to the GP referral area when there is space). You are seen there by a junior dr/ nurse specialist, then a consultant who would refer to the surgical team in a case like OP. Surgical team would come down and assess and make the decision whether or not to admit to a ward. It is a major children's hospital, but I don't know of anyone who has direct access to a ward via GP or otherwise, but clearly other places have different policies which can make it hard to advise OP and others with similar questions.

It sounds like there is no worsening of symptoms since she was seen last night. So I would watch and wait ... but given you are so worried call the GP or turn up there if you are not getting through. Not a and e.

Actually welshweasel I don't think people do understand the processes you describe and how it is all best managed. People aren't taught how to use the NHS and if you asked people on the street how quickly they would get to consult with a surgeon if they saw a GP versus went to A and E I think hardly anyone would have knowledge of what you describe. How and why would they? I honestly think people need to be given more information and I know that many will neither listen nor understand but some of us will!

Welshweasal In most cases I would agree with you. People use A&E far too easily, GPs too if I'm honest. Most things could be treated at home or via a pharmacist, but I stand by what I said about this one. It's my own personal limit after a couple of bad experiences, but I'm not prepared to fuck with abdominal pain, especially when it's a kid. Northumbria NHS Trust (no idea if it's country wide), have posters at all NHS sites listing common problems and where you should go, it lists Pharmacy, GP, WIC, 111 & A& E and abdominal pain is one of only three or four which states get thee to A&E.

In my case when we took a family member in over the holidays, it would have been better for A&E if we could have been sent to surgical assessment from WIC, the area didn't have a protocol in place to make that happen. No idea why.

Thanks for all the replies.

Just got back from GP at our fab surgery. DD diagnosed with mesenteric adenitis which mimics appendicitis. Told to come back if no better as there's a small chance it might be appendicitis.

So relieved it's that. Thanks Welsh for pointing out the referral pathway in one of your posts. I think that should be used as a sticky for all posters to see.

DD still in a lot of pain but also relieved that we don't need to go to hospital. She was also worried that I'd make her have her hair like Topsy when she had appendicitis No fringes today DD!

I truthfully think that we're some of the most 'unhysterical' parents ever. We have lots of kids and normally a dose of calpol and a cuddle and everything's ok. One of our DS ended up with a dislocated finger for days as I just strapped it up (he's super bendy anyway!)

Didn't mention it in my OP (sozzers for drip feeding) but the OOH GP that Dd saw last night was from my old surgery who misdiagnosed my ongoing gallbladder pain as a teen as 'bowel problems'.
I ended up in hospital for weeks after emergency open surgery and sepsis. Perhaps it explains my doubt at his diagnosis.

Our current GP's excellent. The receptionists are kind, professional and couldn't do more to help.
Nowt like some of the experiences in MN.

Anyway, thanks again folk. Sometimes MN can be somewhere where clarity can be honed from overwhelming situations. Other times it's just a splendid bunfightarama

Hopefully it's that then. What did they give her & how long is it ok to leave it beforehand re going back?

Your ex Dr sounds like a nightmare. One that has misdiagnosed loads of people over the years has just retired, thankfully, as my Mum still kept seeing him.

Gp said Buscopan not needed but to take ibuprofen as well as paracetamol. She said 24 hours to reassess.

Glad you got her seen. Hope she gets better soon

Glad you managed to get seen by you're GP and hope your DD is feeling better soon.

👏👏👏 welsh great posts. Wondering if we work in the same hospital!