I. PATIENT’S PROFILE Hospital: Notre Dame de Chartres Hospital Name: patient x Age: 20 years old Sex: female Birthday: March 21, 1991 Civil status: single Nationality: Filipino Date of Admission: September 5, 2011 Religion: Roman Catholic Address: 031 Shangrila Village, Baguio City, Benguet Chief complaint: Right lower quadrant pain Pre-operation Diagnosis: Acute Appendicitis Post-operation Diagnosis: Ruptured Appendicitis Surgeon: Dr. Pablo Candelario Anesthesiologist: Dr. Edgar Montenegro Type of Anesthesia: Subarachnoid Block Anesthesia Time anesthesia began: 6:45 pm Operation Date: September 5, 2011 Time Operation Began: 06:50 pm Time Operation Ended: 07:55 pm Title of Operation: Exploratory Appendicitis Peritoneal Lavage Page | 1
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I. PATIENT’S PROFILE
Hospital: Notre Dame de Chartres Hospital
Name: patient x
Age: 20 years old
Sex: female
Birthday: March 21, 1991
Civil status: single
Nationality: Filipino
Date of Admission: September 5, 2011
Religion: Roman Catholic
Address: 031 Shangrila Village, Baguio City, Benguet
Chief complaint: Right lower quadrant pain
Pre-operation Diagnosis: Acute Appendicitis
Post-operation Diagnosis: Ruptured Appendicitis
Surgeon: Dr. Pablo Candelario
Anesthesiologist: Dr. Edgar Montenegro
Type of Anesthesia: Subarachnoid Block Anesthesia
Time anesthesia began: 6:45 pm
Operation Date: September 5, 2011
Time Operation Began: 06:50 pm
Time Operation Ended: 07:55 pm
Title of Operation: Exploratory Appendicitis Peritoneal Lavage
Page | 1
II. ANATOMY AND PHYSIOLOGY
The appendix is a small, fingerlike appendage about 10 cm (4
in) long that is attached to the cecum just below the ileocecal
valve. The appendix fills with food and empties regularly into
the cecum. Because it empties inefficiently and its lumen is
small, the appendix is prone to obstruction and is particularly
vulnerable to infection (ie, appendicitis).
Appendicitis, the most common cause of acute surgical
abdomen in the United States, is the most common reason for
emergency abdominal surgery. Although it can occur at any age, it
more commonly occurs between the ages of 10 and 30 years (NIH,
2007).
Page | 2
III. PATHOPHYSIOLOGY
A. NARRATIVE:
The appendix becomes inflamed and edematous as a result of
becoming kinked or occluded by a fecalith (ie, hardened mass of
stool), tumor, or foreign body. The inflammatory process increases
intraluminal pressure, initiating a progressively severe, generalized,
or periumbilical pain that becomes localized to the right lower
quadrant of the abdomen within a few hours. Eventually, the inflamed
appendix fills with pus.
Vague epigastric or periumbilical pain (ie, visceral pain that is
dull and poorly localized), progresses to right lower quadrant pain
(ie, parietal pain that is sharp, discrete, and well localized) and is
usually accompanied by a low-grade fever and nausea and sometimes by
vomiting. Loss of appetite is common. In up to 50% of presenting
cases, local tenderness is elicited at McBurney’s point when pressure
is applied. Rebound tenderness (ie, production or intensification of
pain when pressure is released) may be present. The extent of
tenderness and muscle spasm and the existence of constipation or
diarrhea depend not so much on the severity of the appendical
infection as on the location of the appendix. If the appendix curls
around behind the cecum, pain and tenderness maybe felt in the lumbar
region. If its tip is in the pelvis, these signs maybe elicited only
on rectal examination. Pain on defecation suggests that the tip of the
appendix is resting against the rectum; pain on urination suggests
that the tip is near the bladder or impinges on the ureter. Some
rigidity of the lower portion of the right rectus muscle may occur. If
the appendix has ruptures, the pain becomes more diffuse; abdominal
distention develops as result of paralytic ileus, and the patient’s