CASE PRESENTATION

Ikhsan Amanda Putra Bangun Azhari Yusuf Rezka Gusty Sari Khairunnisa Imadiddin

IDENTITY
Name : M. Rizky Sex : Male Age : 16 years Address : Tanjung Bingkuang, Kab. Solok Date of admission : August 2013

Chief Complain
Pain on the lower right stomach since a week before admitted into hospital

Present Illness history

Patient came with pain on the lower right stomach since a week before admitted into hospital. Pain directly felt on the lower right of stomach. Pain felt continually and increased in motion. Patient didnt have any nausea and vomiting. Fever (+), the presence was inconsistently since 1 week ago. Defecation and Urination normal. Flatus (+)

Past Illness history

Patient never felt pain like this before

PHYSICAL EXAMINATION
General State
Consciousness : compos mentis Blood Pressure : 110/70 mmHg Temperature : 38,3 C Pulse : 94/ mnt Respiratory Rate : 20/ mnt

 Head : normochepali Eyes: Conj. Anemis (-), sclera icteric (-) Thorax : Thorax symmetric. Lung resonant. Breath sound vesicular with no added sound. Cardiovascular : good S1,S2, no murmur, no gallop. Abdomen : see Localis state Ekstremities : warm, no edema

Localis state
Ins: Abdomen Distension (-) Aus: intestinal noise (+) Palpation: Tenderness to palpation (+) at right lower quadrant, especially on Mc Burney point. Rebound tenderness (+) at right lower quadrant Felt the mass on right lower quadrant Percussion: Timphany

Laboratory

Laboratory studies :19th August 2013 Hematocrite : 43 % Hemoglobin : 14,9 gr/dL Leukocyte count : 29.200 /L Trombocyte count : 263.000 /L GDS : 118 g/dl Ureum : 37 Creatinin : 1,2

WORKING DIAGNOSIS
Appendicitis Infiltrate

SUPPORTING EXAMINATION
Laboratory examination Rontgen photo abdomen USG Abdomen

Management
Bed rest Semi - Fowler Position IVFd RL 20 drops / minute Ceftriaxon 1 x 2 gr i.v. Metronidazole 3 x 500 i.v. Ranitidin 2 x 1 i.v Tamoliv 3 x 500 i.v. Omeprazole 1 x 1 i.v.

Anatomy

Definitions
Appendix infiltrate is the inflammation process of appendicitis, the spread can be limited by the omentum and the intestines and peritoneum around it to form a mass (appendiceal mass).Appendix mass is generally formed on day 4, since the inflammation begins to occur when no general peritonitis.The mass of the appendix is more often found in patients aged five years or more because the immune system has progressed well and the omentum was long and thick enough to wrap the inflamation.

Etiology
Obstruction of the lumen is a major cause of appendicitis.Fekalit a common cause of obstruction of the appendix.Other causes hypertrophy of lymphoid tissue, the remainder of the barium x-ray examination, low-fiber diet, and helminth infections, including Ascaris. Trauma due to blunt trauma or colonoscopy can trigger inflammation in the appendix. Post appendicitis operation can also be a cause as a result of trauma or fecal stasis

 Appendicitis is usually caused by blockage of the lumen of the appendix by lymphoid follicle hyperplasia, fekalit, foreign bodies, strictures due to fibrosis from previous inflammation, or neoplasm. Closed lumen obstruction caused by obstacles on the proximal and continues to increase in the normal secretion of the distended appendix mucosa.The obstruction of mucus produced by mucous cause suffered dam

 The most common complication is perforation