Name : Muhammad A Name : Muhammad Asyraf syraf
Age : 17 years old Age : 17 years old
Chief Complaint Chief Complaint
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Pain at right lower abdomen since three days agoPain at right lower abdomen since three days agoHistory of Presenting Illness History of Presenting Illness
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Pain started after taing dinner at college canteen three days agoPain started after taing dinner at college canteen three days ago--
No rebound tenderness No rebound tenderness--
Came to Hospital on !"#1#!$1% and too medicine to ease the pain and allowed to goCame to Hospital on !"#1#!$1% and too medicine to ease the pain and allowed to go bacbac
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Pain again and got admitted Pain again and got admitted on !7#1#!$1%on !7#1#!$1% SOCRATES:SOCRATES:
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• SSite: &ight Iliac 'ossaite: &ight Iliac 'ossa •
• OOnset: Pain comes and goes( Increases graduallynset: Pain comes and goes( Increases gradually •
• CCharacter: )harp painharacter: )harp pain •
• R R adiation: Noadiation: No •
• AAlle*iating factors: Nolle*iating factors: No •
• TTime course: Normally lasts 1$+1% minutesime course: Normally lasts 1$+1% minutes •
• EE,acerbating factors: It comes any time,acerbating factors: It comes any time •
• SSe*erity: "#1$e*erity: "#1$ •
• Associated symptoms: No fe*er- *omiting- constipation or dysuriaAssociated symptoms: No fe*er- *omiting- constipation or dysuria
Past medical history Past medical history
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No any past medical history No any past medical history Past surgery historyPast surgery history
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No any past surgery history No any past surgery history 'amily history'amily history
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Patient is /rd child of " childrens( )ocial history # Personal history-
No smoing-
No alcohol-
&esidence : 0ulai-
ccupation : )tudent 2rug history-
No past drug history or allergy2iagnosis
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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 )hchetin+.loomberg5s6
• .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(
• 2unphy5s sign: Increased pain in the right lower uadrant with coughing(
• 0ocher5s 40osher5s6 sign: 'rom the person5s medical history- the start of pain in the
umbilical region with a subseuent 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 abdomenfrom 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(
• 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 anle with one hand and nee with the other hand( he e,aminer rotates the hip by mo*ing the person5s anle 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(
• 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 4counterclocwise 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*oing right sided
abdominal pain(
• )ito*siy 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(-
Urine test. o mae sure that a urinary tract infection or a idney stone isn5t causing your pain(-
Imain tests. Abdominal 9+ray- an abdominal ultrasound or a computeri3ed tomography 4C6 scan to help confirm appendicitis or find other causes for your pain( )coring systems-
Al*arado score +< A score below % is strongly against a diagnosis of appendicitis-while a score of 7 or more is strongly predicti*e of acute appendicitis( In a person with an eui*ocal score of % or "- a C scan is used to reduce the rate of negati*e appendicectomy(2ifferential diagnosis
- Children: =astroenteritis- mesenteric adenitis- Mecel5s
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 leuemia(
- Men: testicular torsion@
- Adults: new+onset Crohn5s disease- ulcerati*e colitis- regional enteritis- renal
colic- perforated peptic ulcer - pancreatitis- rectus sheath hematoma@
- 8lderly: di*erticulitis- intestinal obstruction- colonic carcinoma- mesenteric
ischemia-leaing aortic aneurysm(
Management
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Surery : he newer method to treat appendicitis is the laparoscopic surgery( his surgical procedure consists of maing 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 reuires general anesthesia and it can last up to two hours( he latest methods are N8) appendectomy pioneered in Coimbatore- India where there is no incision on the e,ternal sin and )IB) 4)ingle incision laparoscopic )urgery6 where a single !(% cm incision is made to perform the surgery(
