Appendicitis Case Write Up

 Name : Muhammad Asyraf  Asyraf  Age : 17 years old

Chief Complaint

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Pain at right lower abdomen since three days ago

History of Presenting Illness

- Pain started after taing dinner at college canteen three days ago -  No rebound tenderness - Came to Hospital on !"#1#!$1% and too medicine to ease the pain and allowed to go  bac  - Pain again and got admitted on !7#1#!$1% SOCRATES: •

Site: &ight Iliac 'ossa

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Onset: Pain comes and goes( Increases gradually

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Character: )harp pain

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R adiation: adiation: No

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Alle*iating factors: No

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Time course: Normally lasts 1$+1% minutes

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E,acerbating factors: It comes any time

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Se*erity: "#1$

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Associated symptoms: No fe*er- *omiting- constipation or dysuria

Past medical history

-  No any past medical history Past surgery history

-  No any past surgery history 'amily history

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.oth parents healthy

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Patient is /rd child of " childrens(

)ocial history # Personal history

-  No smoing -  No alcohol - &esidence : 0ulai - ccupation : )tudent 2rug history

-  No past drug history or allergy

2iagnosis

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Physical exam to assess your pain •

Aure+&o3ano*a sign: Increased pain on palpation with finger in right Petit triangle 4can be a positi*e )hchetin+.loomberg5s6

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.artomier+Michelson5s sign: Increased pain on palpation at the right iliac region as the person being e,amined lies on his#her left side compared to when he#she lies on his#her bac(

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2unphy5s sign: Increased pain in the right lower uadrant with coughing(

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0ocher5s 40osher5s6 sign: 'rom the person5s medical history- the start of pain in the umbilical region with a subseuent shift to the right iliac region(

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Massouh sign: 2e*eloped in and popular in southwest 8ngland- the e,aminer   performs a firm swish with his#her inde, and middle finger across the abdomen from the 9iphoid process to the left and the right iliac fossa( A positi*e Massouh sign is a grimace of the person being e,amined upon a right sided 4and not left6 sweep(

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bturator sign: he person being e*aluated lies on her#his bac with the hip and nee both fle,ed at ninety degrees( he e,aminer holds the person5s anle with one hand and nee with the other hand( he e,aminer rotates the hip by mo*ing the person5s anle away from the his#her body while allowing the nee to mo*e only inward( A positi*e test is pain with internal rotation of the hip(

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Psoas sign: Also nown as the ;bra3tso*a5s sign; is right lower+uadrant pain that is produced with either the passi*e e,tension of the right hip or by the acti*e fle,ion of the person5s right hip while supine( he pain that is elicited is due to inflammation of the peritoneum o*erlying the iliopsoas muscles and inflammation

of the psoas muscles themsel*es( )traightening out the leg causes pain because it stretches these muscles- while fle,ing the hip acti*ates the iliopsoas and therefore also causes pain( •

&o*sing5s sign: Pain in the lower right abdominal uadrant with continuous deep  palpation starting from the left iliac fossa upwards 4counterclocwise along the colon6( he thought is there will be increased pressure around the appendi, by  pushing bowel contents and air towards the ileocaecal *al*e pro*oing right sided abdominal pain(

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)ito*siy 4&osenstein65s sign: Increased pain in the right iliac region as the  person is being e,amined lies on his#her left side(

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Blood test.  his allows to chec for a high white blood cell count- which may

indicate an infection(

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Urine test. o mae sure that a urinary tract infection or a idney stone isn5t causing

your pain(

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Imain tests. Abdominal 9+ray- an abdominal ultrasound or a computeri3ed

tomography 4C6 scan to help confirm appendicitis or find other causes for your pain( )coring systems

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Al*arado score +< A score below % is strongly against a diagnosis of appendicitiswhile a score of 7 or more is strongly predicti*e of acute appendicitis( In a person with an eui*ocal score of % or "- a C scan is used to reduce the rate of negati*e appendicectomy(

2ifferential diagnosis -

Children: =astroenteritis- mesenteric

adenitis- Mecel5s

di*erticulitis- intussusception- Henoch+)ch>nlein purpura- lobar  pneumonia-urinary tract infection 4abdominal pain in the absence of other symptoms can occur in children with ?I6- new+onset Crohn5s disease or ulcerati*e colitis- pancreatitis- and abdominal trauma from child abuse@ distal intestinal obstruction syndrome in children with cystic fibrosis@ typhlitis in children with leuemia( -

Men: testicular torsion@

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Adults: new+onset Crohn5s disease- ulcerati*e colitis- regional enteritis- renal colic perforated peptic ulcer - pancreatitis- rectus sheath hematoma@

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8lderly: di*erticulitis- intestinal obstruction- colonic carcinoma- mesenteric ischemialeaing aortic aneurysm(

Management

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Surery : he newer method to treat appendicitis is the laparoscopic surgery( his surgical procedure consists of maing three to four incisions in the abdomen- each

$(!% to $(% inches 4"( to 1!(7 mm6 long( his type of appendectomy is made by inserting a special surgical tool called laparoscope into one of the incisions( he laparoscope is connected to a monitor outside the person5s body and it is designed to help the surgeon to inspect the infected area in the abdomen( he other two incisions are made for the specific remo*al of the appendi, by using surgical instruments( Baparoscopic surgery also reuires general anesthesia and it can last up to two hours( he latest methods are N8) appendectomy pioneered in Coimbatore- India where there is no incision on the e,ternal sin and )IB) 4)ingle incision laparoscopic )urgery6 where a single !(% cm incision is made to perform the surgery(

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Pain : Pain medications 4such as morphine6 do not appear to affect the accuracy of  the clinical diagnosis of appendicitis and therefore should be gi*en early in the  person5s care(Historically there were concerns among some general surgeons that analgesics would affect the clinical e,am in children and thus some recommended that they not be gi*en until the surgeon in uestion was able to e,amine the person for  themsel*es(