APPENDICITIS

MÎȚU ALEXANDRA – SLAGEANA

SERIA D, GRUPA 20
 WHAT IS APPENDICITIS?

 Appendicitis is a inflammation of the appendix,

a small (~3 inches/ 8cm) tube-like organ
attached to the first part of the large intestine.
It is located in the lower right part of the
abdomen and it has no known function.
 It occurs most often between the ages of 10
and 30 and it is believed that more in males
are affected.
CAUSES

 Doctors consider a obstruction (partial or complete) of the appendix to be the main cause.
 The bacteria will multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not
treated promptly, the appendix can rupture and the infection will spread throughout the abdomen (also known as
PERITONITIS).
 The obstruction can be caused by:
 Worms
 Fecal matter (most of the cases)
 Tumors
 Trauma
 SYMPTOMS

 The classic symptoms of appendicitis include:

 Dull pain near the navel or the upper abdomen that
becomes sharp as it moves to the lower right abdomen.
(usually the first sign)
 Loss of appetite
 Nausea and/or vomiting
 Abdominal swelling
 Fever (37,2 – 38,8 Celsius)
 Inability to pass gas
 Almost half the time, other symptoms of appendicitis
appear, including:
 Dull or sharp pain anywhere in the upper or lower
abdomen, back, or rectum
 Painful urination
 Severe cramps
 Constipation
 DIAGNOSIS AND TREATMENT

 Because of the extremely similar symptoms with other

diseases, there is a relatively large number of tests that
need to be made to confirm it.
 Physical examination - If you have appendicitis, your pain
will increase when your lower right belly area is pressed
 Complete blood count test – High level of WBC indicate
that there is an infection
 Urine test – Taken to rule out a UTI or kidney stones
 Ultrasound or CT
 The treatment can vary but the majority of cases will need
surgery. In case you have an abscess, he doctor will prescribe
some antibiotics and drain the abscess before the intervention.
 PATIENT DATA

 Name: Rochelle Lawrence

 Sex: Female
 Date of birth: 04/07/1991
 Age: 25
 Adress: Johnson St 40, Sydney
 Occupation: Lawyer
 Height: 1.73 m ( 5’6 feet)
 Weight: 61 kg (134 pounds)
 Date of the admission: 15/04/2017
 Patient ID : 1103942
 MAIN COMPLAIN

Mrs. Rochelle Lawrence, came on the 15th

of April in the ER accusing a growing pain
in the lower abdomen, nausea and cramps.
The symptoms first occurred two days
ago and since then the patient accuses a
growth in intensity.
 INTRODUCTION

 Dr. Robbins: Hello, Mrs. Lawrence?

 Mrs. Lawrence: Hello, yes that is me.
 Dr. Robbins: Nice to meet you Mrs. Lawrence, I’m Dr. Robbins and I am going to be your doctor
today.
 Mrs. Lawrence: Nice to meet you doctor.
 Dr. Robbins: So tell me, how have you been feeling lately?
 Mrs. Lawrence: Not good actually, that is why I’m here today.
 PRESENT COMPLAINT
 Dr. Robbins: Please go on. What seems to be wrong?
 Mrs. Lawrence: Well, it all started two days ago with a small pain in my abdomen and I thought I might have ate
something bad but the pain still hasn’t gone away and, in fact, it has gotten more intense. Also I’m feeling nauseous and I
have some really bad cramps.
 Dr. Robbins: Can you please tell me more about the pain? Where exactly in the abdomen is it located and on a scale of
1-10 how intense it is?
 Mrs. Lawrence: It’s a really sharp pain, like someone’s stabbing me with a knife. It’s in my lower right side and sometimes
I can feel it around my bellybutton and radiating on my right leg too. As intensity, it’s around 6
 Dr. Robbins: Can you tell me please, does it hurt more when I press the area?
 Mrs. Lawrence: Yes, much more.
 Dr. Robbins: Have you also been vomiting ?
 Mrs. Lawrence: Yes. Twice yesterday.
 Dr. Robbins: Have you taken your temperature?
 Mrs. Lawrence: No I haven’t but I felt really warm yesterday so I think I might have had a fever.
 PAST MEDICAL HISTORY

 Dr. Robbins: I am going to ask you a few more questions about your health. Do you know to be suffering from any
diseases at the moment?
 Mrs. Lawrence: Besides the iron deficiency anemia and mitral valve prolapse with which I was diagnosed two
years ago, nothing that I know of.
 Dr. Robbins: Do you remember about any past illnesses?
 Mrs. Lawrence: I had meningitis when I was 10yo and the usual childhood illnesses: measles and chickenpox. I’ve
also had a UTI two months ago.
 Dr. Robbins: Injuries of any kind?
 Mrs. Lawrence: Nothing severe, just bumps and bruises.
 Dr. Robbins: Have you ever been hospitalized or had any surgeries?
 Mrs. Lawrence: No surgeries but I’ve been hospitalized for about a week when I had meningitis.
 PAST MEDICAL HISTORY

 Dr. Robbins: Do you have any allergies?

 Mrs. Lawrence: Not that I know of.
 Dr. Robbins: Do you take any daily medication?
 Mrs. Lawrence: No but I take an Advil when I get a headache or I have menstrual cramps.
 Dr. Robbins: Is there any chance that you might be pregnant?
 Mrs. Lawrence: I’m not sure but I guess we can test it right?
 Dr. Robbins: Of course we can.
 FAMILY HISTORY

 Dr. Robbins: Do you have any siblings Mrs. Lawrence?

 Mrs. Lawrence: Yes. I have a younger brother and a older sister.
 Dr. Robbins: How’s their health? Do they suffer from any illnesses?
 Mrs. Lawrence: My brother has diabetes and my older sister has astigmatism.
 Dr. Robbins: And what about your parents and grandparents?
 Mrs. Lawrence: My dad also has astigmatism and my mother suffers from hypertension. One of my grandmothers
is diabetic too and the second one passed away a few years ago from a heart attack, and somehow both of my
grandfathers are healthy.
 SOCIAL AND PERSONAL HISTORY

 Dr. Robbins: I have a few more questions and after that we’re done.
 Mrs. Lawrence: Sure.
 Dr. Robbins: Do you smoke?
 Mrs. Lawrence: I used to but I quit 4 years ago.
 Dr. Robbins: That’s a good decision. Do you drink alcohol?
 Mrs. Lawrence: Occasionally. Only when I go to a party with my friends but I don’t abuse it.
 Dr. Robbins: I see here in your file that you’re a lawyer, that must be really stressful right?
 Mrs. Lawrence: I must admit, sometimes it is but I’m usually a very calm person so I don’t stress very often.
 Dr. Robbins: That’s a good thing. Also, how often do you exercise?
 Mrs. Lawrence: I go to the gym 2 times a week, sometimes even 3 if I have enough time.
 Dr. Robbins: Great to hear that.
 OTHER COMPLAINTS

 Dr. Robbins: Tell me Mrs. Lawrence, besides the pain in the abdomen, fever, nausea and vomiting, is there anything
else that is bothering you? Headaches, chest pains, any discomfort while urinating?
 Mrs. Lawrence: No chest pains or discomforts but I have noticed that my urine is a darker yellowish color and I
do sometimes get headaches but I believe it’s from all the papers I have to read.
 Dr. Robbins: Anything else?
 Mrs. Lawrence: No.
 TESTING

 Dr. Robbins: From what you have told me I would like you to remain hospitalized so I can give you some pain
relievers and do more tests in order to confirm the cause of your pain. I will start by doing a abdominal
ultrasound to see what’s happening in there and I will need a blood sample and a urine sample too since you said
you recently had a UTI
 Mrs. Lawrence: Of course, I will do whatever is necessary.
 Dr. Robbins: Do you have any questions so far?
 Mrs. Lawrence: No questions, thank you Dr. Robbins.
 Dr. Robbins: You’re welcome. I will come back later with your results.
Urine Sample Result Normal Value
pH 6 5–7
Density 1,020 1,015 – 1,025
Proteins absent absent Ions (Serum) Result Normal Value
Glucose absent absent Sodium 126 mEq/L 135 – 145 mEq/L
Ketone absent absent Potassium 3,0 mEq/L 3,5 -5 mEq/L
Nitrite absent absent Iron 49mEq/L 60 – 160 mEq/L
Uro-Bilirubin normal normal Calcium 2,3 mEq/L 2,2 – 2,6 mEq/L
Bilirubin absent absent Magnesium 1, 9 mEq/L 1,6 – 2,4 mEq/L

Blood Sample Result Normal Value

Red blood cells 4,36 mil/mm³ 4 - 5,5 mil/mm³  MCV = mean corpuscular volume (average volume of a
Hemoglobin 10,7g/dL 12 – 16 g/dL red blood cell)
Hematocrit 31,0 % 35 – 46 %  MCH = mean corpuscular hemoglobin (average mass of
MCV 70,9 fL 79 – 98 fL hemoglobin per RBC)

MCH 24,2 pg 27 – 32 pg  MCHC = mean corpuscular hemoglobin concentration

(average concentration of hemoglobin in RBC)
MCHC 34,3 g/dL 32 – 36 g/dL
White blood cells 10,85 *10³/mm³ 4,0 – 9,0
*10³/mm³
ULTRASOUND
 EXPLAINING DIAGNOSIS AND MANAGEMENT

 Dr. Robbins: Hello again Mrs. Lawrence. How are you feeling?
 Mrs. Lawrence: Hello Dr. Robbins, I’m better thanks to the medication but it still hurts a little bit. Have you found
out what is causing this?
 Dr. Robbins:Yes actually, I’ve got back your test results. The good news is that you have no UTI or kidney stones,
so the darker color of your urine might have been caused by a low consume of liquids. The bad news is that you
have appendicitis so you will need to stay in the hospital for a few more days.
 Mrs. Lawrence: Appendicitis? I’ve heard of it. Will I need surgery?
 Dr. Robbins:Yes but don’t worry, me and my team will perform this surgery with the help of a laparoscope and
that way you’ll have a smaller scar and the recovery will be much easier and shorter. Do you have any other
questions?
 Mrs. Lawrence: No. Thank you doctor.
 Dr. Robbins:You’re welcome. I’ll see you again after the surgery.
 AFTER SURGERY CHECK UP

 Dr. Robbins: How are you feeling after your surgery Mrs. Lawrence?
 Mrs. Lawrence: Tired and I feel like everything hurts. My abdomen feels really swollen too.
 Dr. Robbins: It is normal to feel this way but don’t worry, everything will go away in a few days.
 Mrs. Lawrence: There’s something I forgot to ask you doctor, will I need to go on a diet after this surgery
 Dr. Robbins: Not exactly. You should be careful what you’re eating these days, nothing too greasy and fat and I
suggest you take some time off from the gym until you’re completely recovered. Also you should drink more
liquids, especially these days.
 Mrs. Lawrence: I will definitely follow your advice. Thank you so much Dr. Robbins.
 Dr. Robbins:You’re very welcome Mrs. Lawrence. Take care of you.
THANK YOU FOR YOUR ATTENTION!!
 BIBLIOGRAPHY

 http://www.healthline.com/health/appendicitis?s_con_rec=true&r=01#Treatment8
 https://medlineplus.gov/ency/article/000256.htm
 http://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis#1