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Scenario
A woman, aged 19 years, comes to the ER with complaints of lower right abdominal pain.
History taking:
• Has regullar menstruation
• Pain since one day ago around the pit of the liver, when it is felt over time down to the
lower right abdomen
• The pain gets worse
• Fever (-)
• There is nausea, vomiting (once)
• Previously never experienced anything like this
• When urinating is not painful
• Diarrhea pooping a week ago, just once
• Pain feels continuous, more ill when standing
• Have been treated with ulcer drug but not cured
• Past Medical History: gastritis
Physical examination:
• General situation: weak, painful
• BP: 120/80 mmHg
• Pulse: 88x / min
• RR: 22x.min
• Axilla temperature: 37.2 c
• Eyes: normal
• Thorax: symmetrical, sonor
• Lung: vesicular / ronkhi (-)
• Heart: murmur (-)
• Abdomen: Darm Countour (-) / Darm Steifung (-), bowel noise decreases
• Palpation: mass (-), tenderness at mcburney point, soepel abdominal wall, flats
• Rectal Touche : RT / DRE pain at 10/11 clock, mass (-), slippery mucosa, no
blood, and mucus on the handscoon
• Acral: warm, edema (-)
• ROM: good
Laboratory:
• Complete Blood:
• Hb: 14
• Leukocytes: 12,000
• Platelets: 300,000
• Plano test (-)
• Ultrasound: no abnormality
Keywords
1. Explain DD and Dx
2. Explain the anatomy and physiology of the colon
3. Explain the etiology and risk factors of appendicitis
4. Explain the pathophysiology of appendicitis
5. Explain symptoms and signs of appendicitis
6. Explain the examination for appendicitis
7. Explain the management of appendicitis
8. Explain the complications and prognosis of appendicitis
9. Explain visceral and somatic pain
Differential diagnosis of Acute Appendicitis
Acute Appendicitis PID Ovarian Cysts Urololithiasis
Epidemiolog Found at all ages Often found in young Often occurs in women In a developing
y Incidence in men and women of reproductive age country, especially in
women is generally The incidence is Less than 20 years old children
comparable highest at the age of and over 50 years old In developing
The highest incidence is 15-24 years countries, especially
in the 20-30 year age in adults
group, and at this age
more in men
Clinical Pain at Mc Burney's Fever, malaise, nausea A lump in the abdomen Hematuria
Manifestation point Bloated accompanied by severe Pain disappears
Accompanied by nausea Lower abdominal pain, complaints With nausea or no
and sometimes vomiting local tenderness, loose Leg Edema vomiting
Decreased appetite pain, muscular defans Crowded Pain over the typical
Stomach ache when Urethritis sign Hormonal disorders: Hydronephrosis
walking or coughing Leukorea menstrual disorders
Visceral pain in the
epigastrium
Examinition Fever is usually mild Lower abdominal Percussion: timpani Physical examination:
with a temperature of tenderness because cecum and palpable kidney
37.5-38.5 ° C Vaginoabdominal: pain ascendens colon enlarged by the
Inspection: no specific occurs if the cervix or contains air presence of
description was found uterus is moved Percussion: deaf from hydronephrosis
Palpation: Pain in the Pain when adnexa is ovarian cysts
right iliac region touched
Anal shaft: pain when
the area of infection can
be achieved with the
index finger
Anatomy of Colon
The Prognosis
• The complications:
• In appendicitis with no complication, the mortality less
Perforation than 0.1%. In appendicitis with complications now the
mortality rate drops to 2-5%, but remains high (10-15%)
Appendix abscess in small children and the elderly. Reduced mortality can
be achieved by early surgery
Purulent peritonitis
Peritoneal cavity
absces
Subdiafragma
absces
Liver abscess