CASE MANAGEMENT,
PRESENTATION-DISCUSSION AND SHARING OF INFORMATION ON
ACUTE ABDOMEN IN ADULT
BY:
EDWIN P. ESTONILO M.D.
General Data:
- TL
- 25-year-old
- Male
- Tondo,
Chief complaint:
Abdominal Pain
HISTORY OF PRESENT ILLNESS
2days PTC epigastric pain, no vomiting, no nausea, (+) dysuria
self medicated
1 day PTA pain localized
at RLQ, (+) nausea, (+)vomiting, (+) anorexia,
(+) consult
PAST MEDICAL HX
Unremarkable
FAMILY MEDICAL Hx
Unremarkable
SOCIAL/ENVIRONMENTAL Hx
3 pack year smoking hx
Occasional alcohol beverage drinker
PHYSICAL EXAMINATION
General :
conscious, coherent, not in CP distress
Vital Sign : CR = 80
BP = 120/80
RR = 20
T
= 37 C
HEENT :
Pink palpebral conjunctivae, anicteric
sclerae, no NAD, no CLAD
Chest / Lung:
SCE, no retraction, clear breath sounds
Heart: Adynamic precordium, NRRR, no murmur
Extremities:
no gross deformities, equal pulses
Abdomen
Flat
normo-active bowel sounds
(+) direct/rebound tenderness RLQ
(+) muscle guarding RLQ
SALIENT FEATURES
25-year-old male
Abdominal pain (epigastric area then
localized to RLQ)
(+) anorexia. (+) vomiting
(+) dysuria
(+) direct/rebound, with muscle guarding at RLQ
COMMON CAUSES OF
ABDOMINAL PAIN
CLINICAL DIAGNOSIS
Do I
need a para-clinical diagnostic procedure?
NO
TREATMENT
Goals of
Treatment:
1. Removal of foci
2. Prevent further fecal
contamination/spillage
3. Decrease/ Minimize peritonitis
4.
Control bacterial spread
SURGICAL
TREATMENT
PRE-OP:
Informed
Consent
Psychosocial Support
Screening
For Medical Problems
Optimize
Physical Condition Of The Patient
Fluid Resuscitation
Prophylactic
Antibiotics
Prepare Materials
For Or
OPERATIVE TECHNIQUE
PROCEDURES:
Muscles
Split
muscles
Peritoneum
Exposure
Evaluation
Procedure
Hemostasis
and Count
Closure
OPERATIVE FINDINGS
Appendix
located retrocecally measuring 7x2x1 cm with
perforation noted at the distal 3rd antimesenteric
border with localized peritonitis
OPERATION DONE
Open Appendectomy
FINAL DIAGNOSIS
Acute perforative
appendicitis with localized peritonitis
POST-OP CARE
Supply
The Basic Needs Of The Patient
Comfort
Antibiotics
Analgesics
Fluids And
Electrolytes
Nutrition
Support
Organ Function
Wound
Care
FOLLOW-UP
Follow-Up Histopath Result
Suture Removal After 1week
Pathophysiology of Appendicitis
Clinical
Details
A diagnosis
of appendicitis usually can be made on the basis of history and physical
examination. Symptoms of appendicitis
may take 4-48 hours to develop lack of appetite and periumbilical
pain followed by nausea, RLQ pain, and vomiting occurs in 50-60% of
patients. Review on the departments
protocol
IS THERE A NEED FOR PERIOPERATIVE ANTIBIOTICS IN MANAGING PATIENTS WITH
ACUTE APPENDICITIS WITH LOCALIZED PERITONITIS?
In patients with suspected appendicitis with
localized peritonitis, preoperatively, the status of the appendix is not
known. It may be normal, at the
congestive, suppurative, gangrenous, or even at the perforative stage.
Because of this situation, we recommend none use of antibiotics
initially.
MCQ
What is the
blood supply of the appendix?
A) appendicial artery from ileocolic
B) SMA
C) IMA
D) Right
common iliac artery
What is the
normal volume capacity of the appendix?
a. 0.1ml
b. 0.2ml
c. 0.3ml
d. 0.4ml
What are the most common site of rupture in the appendix?
- Antimesenteric border
- Proximal third
- Distal third
- Middle third
What are the possible treatment in Acute appendicitis?
- Open Appendectomy
- Laparoscopy
- Medical
- psychiatric
What are the possible treatment in Acute appendicitis?
- Open Appendectomy
- Laparoscopy
- Medical
- psychiatric
Thank you