45/Female with Severe pain abdomen. on examination severe pain in RIF WITH REBOUND TENDER, Vomiting (+) WBC: 27000 ATTACHED CT ABDOMEN
Clinically looks like acute inflamtory or infective condition causing intestinal obstruction ....However CT shows abnormality near periamoullary area ,around head of pancrease and distal CBD probably inflammatory mass causing obstruction... Best would be tri phasic CT for confirmation...till ten keep NPO , start on antibiotics and IV fluids..
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RIF pain rebound tenderness leucocytosis and gross central IHBRD on CT need to be further evaluated. Is there jaundice?
Ac appendicitis !burst urgent surgery should be think of.
History suggests inflammation infection with fluid level seen in CT abdomen see liver lesion may be ruptured appendicitis with peritonitis
What was the diagnosis finally...what was the CT reporting..?
Ac.appendicitisburst .Emergency surery to be undertaken.
Due to appendicitis brust its tends to sepsis that why go for immediat surgery
Acute Appendicitis with peritonitis
@Dr. Syam Sundar Patro
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What is Appendicitis Acute * appendicitis occurs when the vermiform (VER-mi-form) appendix becomes infected with bacteria. Vermiform means shaped like a worm. The appendix is a narrow, finger-shaped tube, usually 3 to 6 inches long, that branches off the large intestine into the lower right side of the abdomen. Inflammation is the body's response to this infection. Once the appendix becomes inflamed, it must be removed so that it does not break, or rupture, and spread the infection to the rest of the abdomen, a condition known as peritonitis * . The appendix has no known function, and its removal has no adverse effect on the body. What is Symptoms of Appendicitis The main symptom of appendicitis is abdominal pain. The pain is at first diffuse and poorly localized, that is, not confined to one spot. (Poorly localized pain is typical whenever a problem is confined to the small intestine or colon, including the appendix.) The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. A second, common, early symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting. Nausea and vomiting also may occur later due to intestinal obstruction. As appendiceal inflammation increases, it extends through the appendix to its outer covering and then to the lining of the abdomen, a thin membrane called the peritoneum. Once the peritoneum becomes inflamed, the pain changes and then can be localized clearly to one small area. Generally, this area is between the front of the right hip bone and the belly button. The exact point is named after Dr. Charles McBurney--McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed. What is facts of Appendicitis The appendix is a small, worm-like appendage attached to the colon. Appendicitis occurs when bacteria invade and infect the wall of the appendix. The most common complications of appendicitis are rupture, abscess, and peritonitis. The most common symptoms of appendicitis are abdominal pain, loss of appetite, nausea and vomiting, fever, and abdominal tenderness. Appendicitis usually is suspected on the basis of a patient's history and physical examination; however, a white blood cell count, urinalysis, abdominal X-ray, barium enema, ultrasonography, CT scan, and laparoscopy also may be helpful in diagnosis. Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be difficult to differentiate appendicitis from other abdominal and pelvic diseases. The treatment for appendicitis usually is antibiotics and appendectomy (surgery to remove the appendix). Complications of appendectomy include wound infection and abscess. Other conditions that can mimic appendicitis include Meckel's diverticulitis, pelvic inflammatory disease (PID), inflammatory diseases of the right upper abdomen (gallbladder disease, liver disease, or perforated duodenal ulcer), right-sided diverticulitis, and kidney diseases. What is Causes of Appendicitis Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, it might be that the lymphatic tissue in the appendix swells and blocks the opening. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside of the appendix. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue that lines the wall of the appendix, for example, inflammation.
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A25-year-old, woman presents for evaluation of abdominal pain. The patient describes her pain as having been present for the past 3 days. The pain is described as constant, exacerbated by movements& associated with subjective fevers and chills. She denies any recent changes in bowel habits, urinary symptoms, or menses. Her last menstrual period was 6 days ago. The physical examination reveals temperature of 38.4°C (101.1°F), pulse rate of 110 beats per minute, blood pressure of 112/70 mm Hg, and respiratory rate of 18 breaths per minute. Her skin is nonicteric. Cardiopulmonary examination is unremarkable. The abdomen is mildly distended and tender in both right & left lower quadrants. Involuntary guarding and localized rebound tenderness are noted in the right lower quadrant. The pelvic examination reveals no cervical discharge; cervical motion tenderness and right adnexal tenderness are present. The rectal examination reveals no masses or tenderness. Laboratory studies reveal white blood cell count (WBC) of 14,000 cells/mm3, a normal hemoglobin, and a normal hematocrit. The urinalysis reveals 3 to 5 WBC/high-power field (HPF), few bacteria, and trace ketones. What are the most likely diagnoses? How can you confirm the diagnosis?
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Appendectomy should be advise or avoid please suggest soon
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