Esprida Vandra Boy

male. Patient FR.  . 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. 16 years old.

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

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

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

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

 Head  Chest and neck  Abdomen  Ekstremity  Limph node : Normally : Normally : Localized status : Normally : Normally .

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

 Digital rectal examination ◦ Inspection : normal perineum and anal skin. tenderness in 11 o’clock direction ◦ Handgloves : faeces (+). discharge (-). smooth rectal mucous. no discharge or mass. ◦ Palpation : normal anal sphincter tone. blood (-). .

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

  Working Diagnosis: Acute appendicitis Differential diagnosis: ◦ Illocaecal lymphadenitis ◦ Colitis ◦ Ureter stone .

2. Urinalysis Routine blood examination Diff count of white blood cell Abdominal ultrasonography . 4. 3.1.

     Hb Platelet Ht WBC Diff count ◦ Lymphocyte ◦ Granulocyte ◦ MID : 15.000/µl : 45.600/µl : : 27.4 %. : 23.5% : 60.3 gr/dl : 310.2% : 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 .

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