Acute Abdomen

Fecal materials exit to peritoneal cavity causing formation of abscess Infection spreads throughout the abdomen (peritoneal cavity)

s/sx: Pale, facial grimace, and abdominal guarding, abdominal pain scale 9/10,guarding, fever, and increased swelling of appendix

Bacterial invasion of peritoneal cavity causing inflammation of the membrane that lines the abdomen peritoneum (Generalized Peritonitis)

Surgery: Emergency Appendectomy

s/sx: Severe Abdominal pain, Abdominal distention, Anorexia, Nausea, Vomiting

Surgery: -Laparoscopy -Hartmanns Operation

PATHOPHYSIOLOGY

PREDISPOSING FACTORS Philippines tropical season Santol season: July to October Advanced age: 65 years old Female

PRECIPITATING FACTORS Ingestion of Santol Seeds High-fat, High Salt Diet Hypertension

Chief complaint: Abdominal Pain

Labs/Diagnostic tests Laboratory tests: Increased WBC, Increased Neutrophil, Decreased Lymphocyte Exploratory Laparotomy: 1-5cm perforation of sigmoid colon with massive fecal spoilage Chest PA: Atheromatous Aorta; Pneumoperitoneum Plain Abdomen: Calcification in the Pelvic Cavity CT Scan of the Whole Abdomen: Tiny calcification, segment of the liver, head and body of the pancreas and in the atrophic uterus

Medical Diagnosis Acute Abdomen secondary to Ruptured Appendix; Generalized Peritonitis secondary to Perforated Sigmoid secondary to Santol Seed/ Cardiac Dysrhythmia T/C Acute Coronary Syndrome

Santol seeds become dislodged in the Appendix

Santol seeds become dislodged in the Sigmoid colon

Increased intraluminar pressure inside the appendix that result to distention of appendix

Increased intraluminar pressure inside the Sigmoid colon

Inflammation and infection spread through the wall of the appendix causing death of tissue. The appendix ruptures due to increased pressure and sharp edges of the seeds

Scybalous (Hardened stool)

Pressure necrosis ulceration and perforation of sigmoid colon