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    Morning Endorsement: Group 10 - Subgroup 1

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    Kevin Marquez
    This document provides medical information about a 14-year-old female patient who presented with right lower quadrant abdominal pain. Her history, physical exam findings, lab results, and differential diagnosis are discussed. She was diagnosed with complicated acute appendicitis based on her pediatric appendicitis score of 9. Her recommended management includes a laparoscopic or open appendectomy followed by postoperative antibiotics and analgesics.

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    Morning Endorsement: Group 10 - Subgroup 1

    Uploaded by

    Kevin Marquez
    18 views30 pages
    This document provides medical information about a 14-year-old female patient who presented with right lower quadrant abdominal pain. Her history, physical exam findings, lab results, and differential diagnosis are discussed. She was diagnosed with complicated acute appendicitis based on her pediatric appendicitis score of 9. Her recommended management includes a laparoscopic or open appendectomy followed by postoperative antibiotics and analgesics.

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    This document provides medical information about a 14-year-old female patient who presented with right lower quadrant abdominal pain. Her history, physical exam findings, lab results, and differential diagnosis are discussed. She was diagnosed with complicated acute appendicitis based on her pediatric appendicitis score of 9. Her recommended management includes a laparoscopic or open appendectomy followed by postoperative antibiotics and analgesics.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    18 views30 pages

    Morning Endorsement: Group 10 - Subgroup 1

    Uploaded by

    Kevin Marquez
    This document provides medical information about a 14-year-old female patient who presented with right lower quadrant abdominal pain. Her history, physical exam findings, lab results, and differential diagnosis are discussed. She was diagnosed with complicated acute appendicitis based on her pediatric appendicitis score of 9. Her recommended management includes a laparoscopic or open appendectomy followed by postoperative antibiotics and analgesics.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    MORNING ENDORSEMENT

    October 21, 2020

    GROUP 10 | SUBGROUP 1
    Arreza, Joegi Mae
    Almocera, Paul Wilson
    Edike, Great Ifechukwu
    Pepito, Lyn Lochin
    Villareal, Yricca Jane
    GENERAL DATA
    ● D.M.
    ● Female
    ● 14 y/o
    ● Single
    ● Filipino
    ● Roman Catholic
    ● Mambaling, Cebu City
    CHIEF COMPLAINT
    ● RLQ abdominal pain
    HISTORY OF PRESENT ILLNESS
    ● 1 Day PTA
    - patient complained of vague periumbilical pain, PS 8/10,
    increasing in intensity which gradually migrated to the right
    lower quadrant (RLQ) area.
    - Associated with 3 episodes of vomiting of recently ingested
    food, volume per episode unrecalled
    - Associated with anorexia, and undocumented fever.
    - Persistence of condition prompted consult and was
    subsequently admitted.
    - No medication was given
    PAST MEDICAL HISTORY
    • Childhood illnesses: None

    • Immunizations: Complete

    • No prior surgeries

    • No allergies
    MENSTRUAL HISTORY
    ● Menarche: 11 yrs. old

    ● Interval: 28 days

    ● Duration: 3-5 days

    ● Symptoms: No dysmenorrhea

    ● LMP: September 21, 2020

    ● Nulliparous
    FAMILY HISTORY
    ● No heredofamilial diseases
    PERSONAL SOCIAL HISTORY
    ● Non-smoker
    ● Non-alcoholic
    ● No illicit drug use
    REVIEW OF SYSTEMS
    ● GENERAL: (+) weight loss, no fatigue, no fever
    ● SKIN: No rashes, lumps or sores.
    ● HEENT: No headache, dizziness, and head injury. No glasses, pain
    and  eye redness. No tinnitus, vertigo, and ear discharge. No colds or
    nasal congestion, epistaxis. No hoarseness, sore throat and bleeding
    gums.
    ● NECK: no lumps, no deviations, no paralysis.
    ● RESPIRATORY: No difficulty in breathing, no cough.
    ● CARDIOVASCULAR: No chest discomfort or pain.
    ● GASTROINESTINAL: No constipation. No diarrhea. (+) RLQ abdominal
    pain with vomiting.
    REVIEW OF SYSTEMS
    ● GENITOURINARY: No pain while urinating, no polyuria, nocturia, no
    flank pain.
    ● MUSCULOSKELETAL: No joint pains or arthritis.
    ● REPRODUCTIVE: No itching, lumps, history of STD.
    ● METABOLIC: No heat or cold intolerance or excessive sweating.
    ● NEUROLOGIC: No headache, no seizure.
    ● PSYCHIATRIC: No suicidal intentions.
    PHYSICAL EXAMINATION
    ● General Survey: Awake, conscious, responsive, not in respiratory
    distress
    ● Vital Signs:
    BP: 120/80 mmHg
    HR: 78 bpm
    RR: 20 cpm
    T: 36.8C
    O2 Sat: 99%
    BMI: 23.1
    PHYSICAL EXAMINATION
    • Skin: no lesion, no color changes
    • Head: scalp without lesions, normocephalic
    • Eyes: anicteric sclera, pink palpebral conjunctiva, pupils equally
    reactive to light
    • Ear: No discharge, acuity good to whisper voice
    • Nose: no nasal flaring, no deformities
    • Throat : oral mucosa is pink and moist, tongue is midline
    • Neck: supple, no palpable lump, no lymphadenopathy
    • Chest and Lungs: Chest was symmetrical, no deformed rib cage, equal
    chest expansion, normal tactile fremitus, lung resonant, clear breath
    sounds on both lung fields.
    PHYSICAL EXAMINATION
    • Heart: Adynamic precordium, PMI at 5th ICS MCL, no heaves, no
    thrills, regular rate, regular rhythm, distinct heart sounds, no
    murmurs.
    • Abdomen: flabby, no lesions, no discolorations, normoactive bowel
    sounds, (+) direct and rebound tenderness in RLQ. (+) Obturator sign.
    (+) Dunphy’s sign
    • Genitourinary: Grossly female, no lesions seen, (-) KPS bilateral
    • Reproductive: External genitalia without lesions. Vaginal mucosa pink.
    Rectovaginal wall intact.
    • Extremities: No edema in both upper and lower extremities.
    PHYSICAL EXAMINATION
    Neurologic
    • CN I : Can distinguish smell of coffee
    • CN II: Extraocular muscles intact
    • CN III, IV, VI: Pupils are equally reactive to light and accommodation
    • CN V: temporal and masseter strength intact, corneal reflexes present
    • CN VII: facial movements intact
    • CN IX, X: (+) gag reflex, uvula midline
    • CN XI: Turns head against resistance
    • CN XII: Tongue is midline on protrusion
    DRE
    • No mass or lesion seen at anal verge, tight sphincter tone, no mass or lesion
    palpated, stool brown, no blood on examining finger.
    WORKING IMPRESSION
     Acute Appendicitis
    LABORATORY RESULTS
    URINALYSIS
    MACROSCOPIC EXAMINATION
    Color DARK YELLOW
    Transparency HAZY
    Volume 30 ml
    Specific Gravity 1.030
    pH 5.0
    Nitrite NEGATIVE
    Protein NEGATIVE
    Sugar NEGATIVE
    Ketones 4+
    Urobilinogen NEGATIVE
    Bilirubin 1+
    Blood NEGATIVE
    MICROSCOPIC EXAMINATION
    WBC/hpf 1-4
    RBC/hpf 0-2
    Epithelial cells FEW
    Mucus threads MANY
    Bacteria MANY
    CLINICAL CHEMISTRY

    Sodium 137.80 mmol/L

    Potassium 3.68 mmol/L


    COMPLETE BLOOD COUNT
    White Blood Cell 25.6 10^9/L 4.0-11.0
    Red Blood Cell 4.6 10^12/L 3.8-5.4
    Hemoglobin 120 g/L 115-148
    Hematocrit 0.36 % 0.38-0.44
    MCV 78.7 fL 80.0-100.0
    MCH 27.3 pg 27.0-31.0
    MCHC 34.7 g/dL 31.0-36.0
    RDW 0.152 0.115-0.150
    Platelet 281 10^9/L 150-450
    Differential Count
    Segmenters 0.90 % 0.45-0.55
    Lymphocytes 0.04 % 0.38-0.45
    Monocytes 0.06 % 0.03-0.06
    Eosinophils 0.01 % 0.02-0.05
    Basophils 0.00 % 0.00-0.01
    BLOOD TYPING O Rh (D) POSITIVE
    CLOTTING and BLEEDING
    TIME
    Clotting Time 5’30” mins 2-5
    Bleeding Time 2’34” mins 1-3
    SEROLOGY RESULTS

    HBsAg NONREACTIVE

    COVID RAPID DIAGNOSTIC

    COVID-19 IgM NEGATIVE

    COVID-19 IgG NEGATIVE


    TEST PERFORMED: SARS-CoV2 Viral RNA Detection Test
    (PCR)

    TEST RESULT: SARS-CoV2 (causative agent of COVID-19)


    viral RNA not detected

    INTERPRETATION: Negative for SARS CoV2 Viral RNA


    DIFFERENTIAL DIAGNOSIS
    Mesenteric Adenitis
    RULE IN RULE OUT
    (+) More common in children (-) Fever
    (+) RLQ abdominal pain (-) Lymphadenopathy
    (+) Vomiting Cannot be completely ruled out
    (+) Direct rebound tenderness
    (+) Leukocytosis
    DIFFERENTIAL DIAGNOSIS
    Acute gastroenteritis
    RULE IN RULE OUT
    major cause of morbidity in (-) Diarrhea
    children
    (+) periumbilical pain Abdominal pain precedes
    vomiting
    (+) vomiting Normoactive bowel sound
    (-) Fever
    Pain is migrating
    DIFFERENTIAL DIAGNOSIS
    Torsion of Ovarian Cyst
    RULE IN RULE OUT
    • Female • No flank, groin and thigh pain
    • Common in reproductive years • Cannot be completely ruled out
    • (+) Abdominal pain
    • Sudden onset and worsen intermittently
    over several hours
    • Vomiting accompanied the pain
    FINAL DIAGNOSIS
     Complicated Acute Appendicitis (Pediatric Appendicitis Score: 9)
    MANAGEMENT
    MANAGEMENT

    Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am
    Fam Physician. 2018 Jul 1;98(1):25-33. PMID: 30215950.
    MANAGEMENT
    • Laparascopic/Open Appendectomy
    • Preoperative Preparations:
    • NPO
    • IV Fluid Maintenance: pLR 100ml/hr x 24h
    • Antibiotic:
    • Ticarcillin + Clavulanic Acid 3.1g IV, q6H or
    • Imipenem + Cilastin 500mg IV, q6H
    MANAGEMENT
    • Postoperative Management:
    • Continue antibiotics for 5-7 days or until Temp <38 C (for 24 hours), able to
    tolerate oral intake, normal WBC with ≤3% band forms
    • Analgesic: Paracetamol 1000mg IV q6h, as needed for pain
    THANK YOU!

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