Esprida Vandra Boy

Patient FR, male, 16 years old, came to the emergency unit of Arifin Ahmad General hospital Chief Complain : Pain in the right lower quadrant abdomen since 2 days before admitted to hospital.

since 2 days before admitted to hospital the patient complain abdominal pain in the right lower quadrant. The pain start at middle quadrant of the abdomen and migrating to the right lower quadrant. The pain described as sharp pain and continuous. Its become more pain if patient walk or move his right leg. Patient also felt nausea but not vomit (-), anorexia (+), fever (-). Patient didnt got a diarrhea.

No complain of mixturation, no history of stone and blood in urine. and no complain about defecation. Patient went to surgeon clinic and doctor said that patient got an appendicitis and must get an operation in the hospital. Then patient go to Emergency Unit of Arifin Ahmad General Hospital.

No history of abdominal trauma No history of blood and stone in urine No history of abdominal pain before.

General condition : looks moderate illness Counsiousness : Composmentis Vital sign BP : 110/80 mmHg HR : 96 x/mnt RR : 18 x/mnt Body Temp : 36,4C

 Head Chest

and neck

Abdomen Ekstremity Limph

node

: Normally : Normally : Localized status : Normally : Normally

Abdomen Inspection

: flat shape, scar (-), darm steifung (-), darm contour (-) Auscultation : Bowel sounds (+), normal Palpation : tenderness and rebound tenderness in McBurney point, musle rigidity in right lower quadrant (+), mass (-). Percution : Timpany

Digital rectal examination

Inspection : normal perineum and anal skin, no discharge or mass. Palpation : normal anal sphincter tone, smooth rectal mucous, tenderness in 11 oclock direction Handgloves : faeces (+), blood (-), discharge (-).

Special Examination Rovsing sign (-) Psoas sign (-) Obturator sign (-) Ballotement (-/-) CVA tenderness (-/-)

Working Diagnosis: Acute appendicitis Differential diagnosis:

Illocaecal lymphadenitis Colitis Ureter stone

1. 2. 3. 4.

Urinalysis Routine blood examination Diff count of white blood cell Abdominal ultrasonography

Hb Platelet Ht WBC Diff count

Lymphocyte Granulocyte MID

: 15,3 gr/dl : 310.000/l : 45,4 %. : 23.600/l :

: 27,5% : 60,2% : 12,3%

Macroscopic

Chemical : normally Microscopic:

Glucose Protein Sediment

Colour : yellow Density : clear

Erythrocyte Leucocyte Epithel Bactery

: (-) : (-) :
: : : :

1-2 5-8 (+) (+)

Appendicitis point pain Leukocytosis Vomitus Anorexia Rebound tenderness phenomenon Abdominal migrate pain Degree of celcius (36,40C) Observation of diff count Total point

: : : : : : : : :

2 2 0 1 1 0 0 0 6

Acute appendicitis

Conservative:
Bedrest with Fowler position Ketorolac iv 2 x 30 mg Cefotaxime iv 2 x 1 mg