CASE REPORT SESSION

APENDISITIS AKUT

Agatha La Marsha
Pembimbing: dr. Amran Sinaga, Sp. B
LAPORAN KASUS


Name: Mrs. Siti Mulyani
 gender : Female
 Age: 19 years old
 MRS: August 20, 2018
 Address: jalan 1 B Rt 003 KEC. Sungai Bahar
 Job: Student
 BAB I
PENDAHULUAN

 Appendicitis is an inflammation that occurs in the Appendix vermicularis.

 Appendix is ​a tubular organ located at the base of the large intestine in the lower right abdomen
 these organs secrete IgA but often cause health problems.
Pain at
 ANAMNESIS
Current Disease History (Alloanamnesis)
• Since ± 1 day SMRS patients complain of pain in the lower right
abdomen.
• Initial pain in the area of ​the gut and loss. Then the pain moves to the
right lower abdomen and continuously.
• Pain increases when the patient moves the body so that the patient is
more comfortable with a lying position.
• History of fever (+), nausea and vomiting (+)
• The patient's appetite and drink decrease.
• The patient was then taken to the Raden mattaher Hospital.
Past medical history : (-)
Family Disease History: (-)
 Physical examination

a. General Conditions: Looks like being sick

b. b. Awareness: Composmentis (E4 / V5 / M6)
c. c. Vital sign Temperature: 36.3oC
Pulse: 98 x / minute
RR: 22x / minute
 Ph y s i c a l e x a m i n a t i o n
Status Generalis
Head
Conjunctiva: anemis (-)
Sclera: jaundice (-)
Lips: no cyanosis
Gums: bleeding (-)
Eye: round pupil, isokor, RC + / +
Neck: Lymph nodes: no enlargement
Tracheal deviation: none
No tumor mass
There is no tenderness.
 PEMERIKSAAN FISIK
Lungs
Inspection: symmetrical left and right
Palpation: tenderness (-), tumor mass (-), left and right fremitus raba
Percussion: left and right sonor
Auscultation: Left and Right vesicular breathing sounds Additional sounds: ronkhi - / -, Wheezing - / -
Heart
Inspection: ictus cordis is not visible
Palpation: ictus cordis palpable in V IC midclavicularis (S)
Percussion: the heart limit is within normal limits
Auscultation: regular S1 / S2, murmur (-)
 PEMERIKSAAN FISIK
Abdomen
Inspection: Flat, inflammatory signs (-), mass (-)
Auscultation: BU (+) is normal
Palpation: McBurney (+) press pain, Rovsing sign (+), Psoas sign (+), Obturator sign (+), muscular defans (-)
Percussion: Timpani Extremities: warm acral, edema - / -, CRT <2 seconds
 H A S I L L A B O R ATO R I U M ( 5 F E B R U A R I 2 0 1 8 )
Jenis Pemeriksaan Hasil Normal Jenis Pemeriksaan Hasil Normal
DARAH RUTIN
FAAL HATI
WBC 14,99 (3,5-10,0 103/mm3)
Protein total 7,6 mg/dL 6,4-8,4 mg/dL
RBC 4,17 (3,80-5,80 106/mm3)
Albumin 3,8 mg/dL 3,5-5,0 mg/dL
HGB 12,2 (11,0-16,5 g/dl) Globulin 3,8 mg/dL 3,0-3,6 mg/dL
PLT 338 (150-390 103/mm3) SGOT 26 <40
GDS 78 SGPT 19 <41
ELEKTROLIT
FAAL GINJAL
Ureum 14 15-39 mg/dL Na 142,18 135-148 mmol/L

Kreatinin 0,5 0,6-1,1 mg/dL K 3,58 3,5-5,3 mmol/L

Cl 108,14 98-110 mmol/L
Ca 1,20 1,19-1,23 mmol/L
LED 11 mm/jam
 DIAGNOSIS
Apendisitis Akut
TATA LAKSANA

 Apendektomi
 IVFD 20 tpm
 Inj Ketorolac 1 amp
 Inj Ceftriaxone 2x1 gr
 Inj Ranitidin 2x1 amp
PROGNOSIS

 Ad vitam : bonam
 Ad functionam : bonam
 Ad sanationam : bonam
APPENDIKS

tubular and luminous organs

length  10 cm (3-15 cm)
diameter around 0.5-0.8 cm
The narrow lumen is in the
proximal section, extending
distally
Intraperitoneal location,
covered by mesoappendix
Retroperitoneal position
VARIASI LETAK APENDIKS
PERDARAHAN APENDIKS
 Mucous production1-
2mL

Mucus is released into

ave a small
the lumen of the
amount of lymph
appendix and then
tissue
flows into the cecum

 FISIOLOGI APENDIKS

Produced by
GALT (Gut Slime barriers ->
Associated pathogenesis process
Lymphoid Tissue)

Imunoglobulin
sekretoar
 APENDISITIS
Incidence of developed countries> developing countries
The highest incidence in the age group 20-30 years
The incidence found in young adult males is higher
Etiologi dan Faktor Risiko
• blockage
• bacteria
• Constipation and laksative
 PATOFISIOLOGI APPENDISITIS AKUT

• Occurred in the first 24-28 hours covering the mucosa and the entire layer of the appendix, the walling-off attempts to close
the appendix with the omentum, small intestine, or adnexa to form a periapendicular mass
• In the appendix: tissue necrosis (abscess) that can be perforated
• If an abscess is not formed, appendicitis will heal and the periapendicular mass will calm down and break down
• The appendix does not heal completely -> form scar tissue -> adhesions with surrounding tissue -> acute exacerbations
 PATOFISIOLOGI APPENDISITIS

• Mucus accumulates in the lumen of the appendix FASE • Blocked arteries -> ischemia ->
Increased intralumen pressure so that it suppresses
the appendix wall Vasa lymphatics, veins, arteries
INFLAMASI infarction -> perforation
Complications: periapendikuler
Obstruction due to lymphatic and venous pressure ->
infiltrate / abscess or peritonitis
fluid extravasation -> edema and hemorrhagic edema

• Edema -> the gap between the epithelium will

stretch -> translocation of m.o from the lumen
to the submucosa Inflammation -> pus goes
into the lumen -> intraluminer pressure me ↑ -
> the arteries on the wall come under pressure

FASE
FASE PERFORASI
OBSTRUKSI
 ANAMNESIS
W
• Abdominal pain DIAGNOSIS
• Nausea vomiting
• Obstipasion PALPASI
• fever McBurney's pain Press release pain
(Rebound Tenderness) Local muscular
defans Lower right quadrant hyperesthesia
INSPEKSI Right rectus rigidity

The patient stoops down

while holding the right
stomach
PERKUSI
pain

RECTAL TOUCHER
Pain between 10-11 AUSKULTASI
Within normal limits if there
are no complications
LABORATORIUM RADIOLOGI

•Leukosit ↑ •USG ->

•Neutrofil↑ appendiks size
•CRP↑ >6cm,
 Skor Alvarado

CLICK
HERE

1–4 : sangat mungkin bukan appendisitis akut  observasi

5–7 : sangat mungkin appendisitis akut  antibiotik
8 – 10 : pasti appendisitis akut  operasi
differential diagnosis
• Intususepsi
• Divertikulitis meckel
• Acute Gastroenteritis
• urinary tract infection
Management of Appendicitis

Infusion and crystalloid administration for patients with
clinical symptoms of dehydration or septicemia Satisfy the
patient, do not give anything orally Giving analgesics should be
consulted by a surgeon. Giving antibiotics i.v. in patients
undergoing laparotomy. Consider the possibility of an ectopic
pregnancy in women of childbearing age and qualitatively
positive beta-hCG.
Management of Appendicitis
Non-operative therapy
• antibiotic
• Rever to Sp.B

• Operative Therapy
Pre-operative Operative Post-operative

Open Laparascopy administration

Antibiotic Antibiotikc
appendictomy appendictomy of fluids
 PROGNOSIS APPENDISITIS

 The mortality from Appendicitis in the USA declined steadily from 9.9% per 100,000 in 1939 to 0.2% per
100,000 in 1986.
 Factors that cause a significant decrease in the incidence of Appendicitis are means of diagnosis and
therapy, antibiotics, i.v fluids are getting better blood and plasma availability, as well as an increase in the
percentage of patients receiving therapy right before perforation
TERIMA KASIH