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ACUTE APPENDICITIS JI CLEOFE, MYANNE C
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ACUTE APPENDICITISJI CLEOFE, MYANNE C

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KO, 23/F Filipinosingleborn on 7-19-80 at Manila,

DOA: 7-6-10 Admitting impression: Acute AppendicitisAttending MD: Dr. PrevosaOperation done: AppendectomyDOD: 7-8-10

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Cc: abdominal pain

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1 day PTA patient +epigastric pain, tolerable, nonradiating.

+anorexia and nausea. - vomiting - fever . +Buscopan, Kremil S

and Diatabs no relief. - consult done.

Several hr PTC, patient noticed a shift of pain to her RLQ, tolerable and non radiating.

+4 episodes of vomiting of PIF.

+anorexia and nausea. - fever. + Consult + lab workups done. Patient was then referred to Valenzuela General Hospital and then later referred to our institution hence subsequently admitted.

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Past Medical Hx: U/R Family history: U/R OBGYNE history: G0P0 Personal social history: U/R

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: conscious coherent NICRD HR- 81 RR-18BP 110/80 T- 36.9 Anicteric sclera, pink palpebral conjuncitiva, no

cervicolymphadenopathy, no nasoaural discharge Symmetrical chest expansion, no retractions, clear

breath sounds Adynamic precordium, normal rate regular rhythm,

no murmur Flabby, NABS, rigid + direct and rebound

tenderness RLQ + psoas sign + obturator sign (-) rovsing sign

GNE, + FEP, no cyanosis, no edema DRE: no external lesions no skin tags with good

sphincter tone, no mass noted with fecal material on tactating finger no blood noted.

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A> Acute Appendicitis P> A

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Hgb hct WBC Segmenters Lymphocytes Monocytes126 0.40 11.6 0.81 0.16 0.03

CBC- 7-6-10 Valenzuela General Hospital

Urinalysis 7-6-10 Valenzuela General Hospital

RBC 0-2/hpf,WBC 1-4/hpfBacteria: occasional

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Pt. Stayed for 2 hospital days. Upon admission, D- NPO I- D5 LR IL x 6hrs E- Cefuroxime 15 gm/IV then 750 mg

q12 T- Appendectomy

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Postop hours are unremarkable. Was on pain control medications, Ketorolac 30mg q8 TIV x 3 days and Nubain 10 mg IV. Was then shifted from NPO to general liquid to soft diet. Day 1 post op, shifted to oral meds. Discontinued IVF. Day 2 post op, patient improved, discharged.

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convergence of the 3 taenia coli at the junction of the cecum, tip can be found at either:

1. retrocecal- MC 2. pelvic 3. subcecal 4. preileal 5. right pericolic position Blood supply: Appendiceal artery An Immunologic organ.

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>most common abdominal surgical emergency >It is initiated by obstruction of the appendix by a

fecalith, inflammation, foreign body, or neoplasm. Obstruction leads to increased intraluminal pressure, venous congestion, infection, and thrombosis of intramural vessels. If untreated, gangrene and perforation develop within 36 hours.

> disease of the young. 40% cases= 10-29yo patients Variations in the position of the appendix, age of the

patient, and degree of inflammation make the clinical presentation of appendicitis notoriously inconsistent

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Early: periumbilical pain; later: right lower quadrant pain and tenderness.

Anorexia, nausea and vomiting, obstipation.

Tenderness or localized rigidity at McBurney point.

Low-grade fever and leukocytosis  

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> Abdominal pain (centered initially in the lower epigastrium or periumbilical area, later localizes at the RLQ)

> Anorexia >Vomiting > Mild temperature

elevation > RLQ tenderness/

Mcburney’s point >Rovsings sign > psoas sign >obturator sign

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Will depend on: 1. anatomic location of the inflamed

appendix 2. the stage of the process (simple/

ruptured) 3. patient’s age 4. patient’s sex

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CBC Mild leukocytosis (10,000- 18,000)

Urinalysis r/o UTI as focus of infection

IMAGING

Plain film abdomen + fecalith is suggestiveGraded compression sonography*accurate

+ appendicolith establishes diagnosis, + thickening of the appendiceal wall and periappendiceal fluid is highly suggestive

Transabd/ trans vaginal ultrasonography r/o gyne conditionsHigh resolution, computed tomography + dilated, thickened wall of the appendix,

+ arrowhead sign

Laparoscopy (dx & tx)

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Characteristic Score

M = Migration of pain to the RLQ

1

A = Anorexia 1

N = Nausea and vomiting

1

T = Tenderness in RLQ

2

R = Rebound pain 1

E = Elevated temperature

1

L = Leukocytosis 2

S = Shift of WBC to the left

1

Total 10

•score of 3 or lower had a 3.6% incidence of appendicitis

•scores of 4-6 had a 32% incidence of appendicitis

•scores of 7-10 had a 78% incidence of appendicitis

ALVARADO’S SCORE

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> ensure adequate hydration >correct electrolyte abnormalities > manage co-morbid illness > OPEN APPENDECTOMY > LAPAROSCOPIC APPENDECTOMY > INTERVAL APPENDECTOMY

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Four possible incision sites: 1. Mcburney (oblique) 2. Rocky Davis (transverse) 3. R paramedian 4. Midline (ex lap)

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Overall mortality rate in ruptured AP: 3%. Complications: wound infection, abscess.

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Things You Don't Want To Hear During Surgery:

"Better save that. We'll need it for the autopsy."

"Someone call the janitor - we're going to need a mop."

"Accept this sacrifice, O Great Lord of Darkness"

"Bo! Bo! Come back with that! Bad Dog!"

"Wait a minute, if this is his spleen, then what's that?"

"Hand me that...uh...that uh.....thingie."

"Oh no! I just lost my Rolex."

"Oops! Hey, has anyone ever survived 500ml of this stuff before?"

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