CASE PRESENTATION

DR. SANJIDA AHMED

MEDICAL INTERN
DIBBA HOSPITAL
 Patient Details:

NAME:Shanti Miah Abdur Rashid

Age: 33 years old
Gender: Male
CMrn Number: 6486664
Nationality: Bangladeshi
Marital Status: Married
 CHIEF COMPLAINT:

Referred from emergency with right abdominal pain and vomiting

 History Of Present Illness

 The 33 year old male patient presented to the ER complaining of severe abdominal pain in the right
side, which has started today since afternoon.
 The pain is stabbing in nature and increased in severity since evening. It is aggravated by movement
and not relieved by anything. The pain doesn’t radiate and is 10/10 on Wong Baker Scale.
 He has no history of chronic disease.
 He has associated symptoms of nausea and vomiting. He vomited twice since afternoon. The vomitus
was food particles
 There is no fever and had no previous history of similar pain
 SYSTEMIC REVIEW: Unremarkable

CNS: No blurring of vision, lack of concentration or any memory loss.

ENT: No ear pain, nasal congestion or sore throat
GIT: Right abdominal pain, no constipation and diarrhea
GIT: Normal urine output and no burning micturition
CVS: No chest pain, palpitations or shortness of breath.
Respiratory: No cough, no shortness of breath.
Musculoskeletal: No muscle stiffness or joint swelling.
PAST MEDICAL AND SURGICAL HISTORY:

• The patient has no known Diabetes Mellitus. Hypertension or Asthma

• No previous surgical histories
FAMILY HISTORY

Family history is negative

 TREATMENT HISTORY

• The patient has no active medications history as of now

• No known allergies
 SOCIAL HISTORY

• The patient denies alcohol consumption

• No smoking nor drug abuse
• The patient is on normal diet and does not excercise
 Physical Examination

The patient was alert, conscious ,afebrile and well nourished. He looked ill while lying
uncomfortably He had an IV cannula inserted
Temperature: 37 Celsius
Heart Rate:86
BP: 118/70
SpO2: 99%
Weight: 69 kg
 GENERAL EXAMINATION:

CNS: The patient was alert conscious, afebrile and well oriented.
EYES: No jaundice, No pallor, normal conjunctiva
Mouth: No central cyanosis , average oral hygiene
NECK: No elevated JVP , No lymphadenopathy
HANDS: Normal temperature , No clubbing , No peripheral cyanosis, No deformity, No leukonychia ,
No koilonychia , No tremors , No flapping tremors, No scars , No palmer erythema.
LEGS: Distal pulses are present. No scars , No ulcers , no pedal oedema , no pitting edema
SYSTEMIC EXAMINATION:

LUNGS : Clear to auscultation and percussion. Non labored respiration

Heart : Normal rate , regular rhythm , no murmur , gallop or edema
MSK: No deformity , no joint pain
Psychiatric: Cooperative, appropriate mood and affect
LOCAL EXAMINATION: Abdominal
Examination

Abdomen was soft and lax, no organomegaly, right iliac fossa tenderness.
 Rebound tenderness positive
 Mcburney’s sign positive
 Psoas sign positive
 Rovsings sign positive
 Obturators sign negative
 Dunphys sign negative
 Differential Diagnosis:

In Children: Urinary tract Infection, Gastroenteritis, Henoch Schonlen Purpura, Mesenteric Adenitis,
Pneumonia

In Women: Ectopic pregnancy, Ovarian cyst or torsion, dysmenorrhea, menarche, Pelvic inflammatory
diseases
Differential Diagnosis:

In Adults: Crohn’s Disease, Colonic carcinoma ,,Cholecystitis ,Bacterial enteritis, Mesenteric

adenitis, Enterocolitis ,Pancreatitis ,Perforated duodenal ulcer

In Men: Testicular torsion

LAB INVESTIGATIONS:
Test name Result
WBC 17.7x10(3)/mcl
RBC 4.56x10(6)mcl
Hct 38.30%
Hgb 13.6 gm/dL
MCHC 35.5gm/dL
MPV 9.30 Fl
Neutro % 90.90%
Lymph% 5.20%
Eos% 0.10%
Creatinine 56.6 umol/L
Neutro Absolute 15.53x10(3)mcL
CRP 5.0 mg/L
Urine Analysis

UA Appear Cloudy
UA Color Yellow
UA pH 8.5(High)
UA Glucose Negative
UA RBC 1-2
UA WBC 2-4
UA Amorph pO4 SEEN
UA Ketones Negative
 RADIOLOGICAL
INVESTIGATIONS:

CT Abdomen without Contrast: Appendix is dilated measuring 11mm with periappendicular fat
stranding . No pelvi- abdominal ascitis
 DIAGNOSIS

Acute Appendicitis
 Appendicitis

• Appendicitis is an inflammation of appendix that develops most

common in adolescents and young adults.
• Appendicitis he most common cause for acute, severe abdominal
pain.
• It is an emergency condition that requires prompt surgery. If
delayed it can burst and cause complications
 • TRAUMATIC INJURY TO THE
ABDOMEN
• FAECOLITH OR FIBROTIC
STRICTURE BLOCKS THE INSIDE OF
APPENDIX
Causes Of • GENETICS VARIANT THAT
PREDISPOSES A PERSON TO
Appendicitis: OBSTRUCTION OF THE
APPENDICEAL LUMEN
• BACTERIAL PROLIFERATION
• TUMOR
Causes Of
Appendicitis:
 Clinical Features:

Symptoms:
1. Periumbilical pain
2. Pain shifts to RIF /RLQ
3. Anorexia
4. Nausea/vomiting
5. Diarrhea
 Clinical Features:

Signs:
• Pyrexia
• Localized tenderness in RIF
• Muscle guarding and rigidity
• Rebound tenderness
• Pain on percussion and coughing : Dunphy’s Sign
 Clinical Features:

• Rovsing’s sign: RIF pain on palpating LIF

• Pointing sign
• Psoas sign : Pain on hip extension
• Obturator sign: spasm of the muscle can be demonstrated by flexing and internal
rotation of the hip cause pain in the hypogastrium
Diagnosis Of Appendicitis:
Radiological Investigations:
Radiological Investigations:
Radiological Investigations:
• Standard small incision in the right lower part of the abdomen
• 3-4 incisions are made.
• Pneumoperitoneum established in the umbilicus
• Appendix tip is dissected, meso appendix dissected down with harmonic AC close to the
wall of appendix, appendix stump was trigly ligated with endo loop and cut in between.
• Hemostasis is secured
• Skin incisions are closed via skin stapler or suturing
COMPLICATIONS:
THANKYOUUU 