Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 45 views

    Morning Endorsement: October 7, 2020 Group 10 - Subgroup 3

    Uploaded by

    Deomicah Solano
    The patient is a 39 year old male construction worker who presented with sudden onset of right lower quadrant abdominal pain that radiated to the periumbilical area. Physical exam revealed tenderness over McBurney's point. Ultrasound showed a non-compressible tubular structure in the right iliac fossa consistent with appendicitis. Laboratory tests were normal except for mild leukocytosis. The diagnosis was uncomplicated acute appendicitis, for which the patient underwent open appendectomy with antibiotic prophylaxis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Morning Endorsement: October 7, 2020 Group 10 - Subgroup 3

    Uploaded by

    Deomicah Solano
    45 views26 pages
    The patient is a 39 year old male construction worker who presented with sudden onset of right lower quadrant abdominal pain that radiated to the periumbilical area. Physical exam revealed tenderness over McBurney's point. Ultrasound showed a non-compressible tubular structure in the right iliac fossa consistent with appendicitis. Laboratory tests were normal except for mild leukocytosis. The diagnosis was uncomplicated acute appendicitis, for which the patient underwent open appendectomy with antibiotic prophylaxis.

    Original Title

    APPENDICITIS

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The patient is a 39 year old male construction worker who presented with sudden onset of right lower quadrant abdominal pain that radiated to the periumbilical area. Physical exam revealed tenderness over McBurney's point. Ultrasound showed a non-compressible tubular structure in the right iliac fossa consistent with appendicitis. Laboratory tests were normal except for mild leukocytosis. The diagnosis was uncomplicated acute appendicitis, for which the patient underwent open appendectomy with antibiotic prophylaxis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    45 views26 pages

    Morning Endorsement: October 7, 2020 Group 10 - Subgroup 3

    Uploaded by

    Deomicah Solano
    The patient is a 39 year old male construction worker who presented with sudden onset of right lower quadrant abdominal pain that radiated to the periumbilical area. Physical exam revealed tenderness over McBurney's point. Ultrasound showed a non-compressible tubular structure in the right iliac fossa consistent with appendicitis. Laboratory tests were normal except for mild leukocytosis. The diagnosis was uncomplicated acute appendicitis, for which the patient underwent open appendectomy with antibiotic prophylaxis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    Morning Endorsement

    October 7, 2020
    Group 10 | Subgroup 3

    Alkuino, Winkle Jones


    Belderol, Jacqueline
    Madabushi, Sindhu
    Manywa, Christian
    Selvakumar, Gowthamram
    Solano, Deomicah
    General Data
    • B.J
    • 39 y/o
    • Male
    • Married
    • Construction Worker
    • Mambaling, Cebu
    Chief complaint
    Right Lower Quadrant Abdominal Pain
    History of Present Illness
    • 1 day PTA
    • Patient had sudden onset of gnawing periumbilical pain, PS of 5/10.
    • The pain started two hours after dinner, and radiated to the right
    lower quadrant.
    • Pain in the RLQ was sharp and jarring in characteristic.
    • Walking aggravated the pain, while lying on the patient’s left side
    was a relieving factor.
    • No fever, anorexia, nausea, vomiting or diarrhea noted.
    Past Medical History
    • No known Medical illness
    • No Maintenance Medications
    • Non asthmatic
    • No known food and drug allergies
    • No history of previous hospitalizations or surgeries
    Family History
    • Father is well with no known medical conditions.
    • Mother is a known hypertensive.
    • No heredofamilial diseases.
    Personal and Social History

    • High school graduate


    • Usual diet include rice, meat, and veggies
    • Smokes 5-6 sticks/day starting at the age of 16 (23 pack years)
    • Drinks alcohol occasionally (1-2 glass of beer/occasion)
    • No history of illicit drug use
    Review of Systems

    • General: No fever, no changes in weight.


    • Skin: No rashes, lumps and sores.
    • HEENT: No headache. No hearing problems. No nasal stuffiness.
    No sore throat and bleeding gums.
    • Respiratory: No difficulty in breathing. No cough.
    • Cardiovascular: No chest pain or discomfort.
    Review of Systems
    • Gastrointestinal: (+)RLQ pain. (+) Periumbilical pain. No nausea or
    vomiting. No constipation or diarrhea.
    • Genitourinary: No dysuria, polyuria, and hematuria.
    • Musculoskeletal: No muscle or joint pain. No stiffness.
    • Psychiatric: No suicidal intentions.
    PHYSICAL EXAMINATION
    •General Survey: Awake, conscious, coherent not in respiratory distress
    •Vital signs: HR: 88bpm
    BP : 100/60 mmHg
    RR: 20 cpm
    Temp: 36.7 C
    O2 sat: 99%
    Height: 5 ft 5 in.
    Weight: 69 kg
    BMI: 25.3 (Overweight)
    PHYSICAL EXAMINATION

    • HEENT: Scalp without lesions, normocephalic. Anicteric sclerae,


    pink palpebral conjunctiva, pupils are round, equally reactive to
    light. No hearing deficits. No nasal discharges. Oral mucosa is
    pink and moist. Tongue is midline.
    • Neck: Neck is supple. Trachea is midline. No palpable masses.
    • Chest and Lungs : Equal chest expansion. Clear breath sounds,
    no rales, no wheezes.
    • Cardiovascular : Adynamic precordium, Distinct heart sounds,
    regular rhythm. No murmurs.
    PHYSICAL EXAMINATION
    • Abdomen: Flat abdomen, Normoactive bowel sounds,
    Tympanitic on all four quadrants. (+) Dunphy’s sign (+)
    McBurney’s sign (+) Rovsing’s sign (+) Psoas sign. (-) Obturator
    sign, (-) Rebound tenderness. No hepatomegaly or
    splenomegaly noted.
    • Extremities: No edema in both upper and lower extremities.
    • Musculoskeletal : No joint deformities.
    • GUT: (-) Kidney punch test.
    • DRE: No perirectal lesions. External sphincter tone intact.
    Working Impression
    • Uncomplicated Acute Appendicitis (Alvarado Score: 3)
    DIFFERENTIAL DIAGNOSIS
    Right-sided Diverticulitis
    RULE IN RULE OUT
    • RLQ pain No vomiting
    • Periumblical gnawing pain No anorexia
    • Abdominal tenderness No hematochezia
    Mostly asymptomatic
    Ureterolithiasis

    Rule in Rule out


    Male Colicky flank pain (renal colic)
    Age No Hematuria
    Lower abdominal pain with No Nausea
    sudden onset not related No Vomiting
    to any precipitating event
    Acute Mesentric Adenitis

    Rule in Rule out


    RLQ pain More common in pediatric patients
    RLQ tenderness No fever
    No diarrhea
    No anorexia
    No nausea or vomiting
    No gaurding
    No history of URTI
    LABORATORY
    RESULTS
    Complete Blood Count
    RESULT REFERENCE
    White blood cells 9.3 (x109/L) 4.0-10.0 (x109/L)
    Red blood cell 4.8(x1012/L) 4.50-5.50
    Hemoglobin 152 g/L 140-170
    Hematocrit 0.46 0.42-0.60
    MCV 96.9 80-100 fL
    MCH 32.1 H 27.0 - 31.0 pg
    MCHC 33.1 g/dL 31.0-36.0 g/dL
    Platelet 152 (x109/L) 150-450 (x109/L)
    Complete Blood Count Cont'd

    Differential count
    % Reference (%)
    Segmenters 0.74 H 0.55-0.65
    Lymphocytes 0.18 L 0.25-0.35
    Monocytes 0.06 0.03-0.06
    Eosinophils 0.02 0.02-0.04
    Basophils 0.00 0.00-0.01
    Clinical Chemistry

    RESULT REFERENCE
    Sodium 138.10 mEq/L 135-148
    Potassium 3.67 mEq/L 3.5-5.0
    Blood Typing, Bleeding time and Clotting Time

    BLOOD TYPE O Rh (D) Positive


    RESULT REFERENCE

    Clotting Time 3 min 46s 2-5 min


    Bleeding Time 2 min 22s 1-3 min
    Clotting Factors

    RESULT REFERENCE
    Prothrombin time 14.00 s 10.00-14.00 s
    Activity 86% > or = 70%
    INR 1.18 0.7- 1.3
    Ultrasonography

    Tubular, hypoechoic, blind-ending structure


    seen on the right iliac region, measuring 3.7 x
    0.46 x 0.77 cm, surrounded by ill-defined
    hypoechoic structures. It is non-compressible
    and elicits rebound tenderness with probe
    manipulation. No abnormal fluid collection
    seen.
    Urinalysis
    • Physical Properties
    • Color: Dark yellow
    • Transparency: Hazy

    •Clinical Properties
    • pH: 5.5
    • Specific Gravity: 1.030
    • Negative Protein and Glucose

    •Flowcytometry
    • RBC: 0-1/HPF
    • WBC: 2-4/ HPF
    • Epithelial cells: FEW
    • Bacteria: FEW
    • Mucus Threads: MODERATE
    Final Diagnosis
    • Uncomplicated Acute Appendicitis (Alvarado Score: 4)
    Management
    • Open appendectomy – primary approach to the treatment of acute
    appendicitis

    • Laparoscopic appendectomy
    • Longer to perform
    • Less post-op pain
    • Faster recovery
    • Lower incisional surgical site infection rate
    Management
    • Antibiotic prophylaxis (Uncomplicated appendicitis)
    • Recommended for the prevention of surgical site infections and intra-
    abdominal abscess
    • Cefoxitin 2g IV single dose
    • Alternative:
    • Ampicillin-sulbactam 1.5-3g IV single dose, or
    • Amoxicillin-clavulanate 1.2-2.4g IV single dose
    • Patients allergic to beta-lactam antibiotis:
    • Gentamicin 80-120 mg IV single dose + Clindamycin 600 mg IV single dose

    You might also like