The PatientDr. Schinko's

Appendicitis Case Study 18 year old African American male awakened from sleep yesterday morning with RLQ (right lower quadrant) abdominal pain associated

with subsequent nausea and vomiting, anorexia, fever and chills. Normal bowel movements until yesterday. No urinary

symptoms, cough, shortness of breath, or chest pain.

PMH: (Past Medical History): asthma PSH: (Past Surgical History) tonsillectomy as child Meds: albuterol inhaler prn (when needed) FH: (Family History): Hypertension (HTN), Diabetes (DM), Coronary Artery Disease (CAD) SH: (Social History)Does not smoke or drink alcohol. College student. ROS: (Review of Systems): as above, otherwise negative

Physical Exam18 yo AAM in acute distress, holding

abdomen. (year old, African American Male)

Temp:100.7

Heart Rate: 97

Blood Pressure:125/67

Respirations: 22

Oxygen Saturation: 98%

Physical Exam Cont.HEENT: (Head, Ears, Eyes, Neck, Throat) anicteric sclera (without

jaundice), conjunctiva pink

Lungs: clear and equal bilaterally

Heart: RRR - Regular Rate and Rhythm

Abdomen: Firm, slightly distended, RLQ (right lower quadrant)

tenderness with guarding and rebound

Rectal: heme negative, R tenderness (right)

Extremities: no deformity or cyanosis

Neuro: AAO X 3, grossly intact (awake, alert, and oriented to

people, place and time)

1. What is the differential diagnosis (DDx)? (include at least 5 possible diagnoses with explanations - do not put this in brochure - on a separate page)

A. Most likely - Appendicitis

B. Next likely - explanation

C. Next likely - explanation

D. Next likely - explanation

E. Next likely - explanation

2. What studies (tests, etc.) do you think will help to differentiate the diagnosis? (include the risks and benefits; do not put on this information on your brochure.

Basic Anatomy

Plain abdominal x-ray (KUB) with white arrow pointing to an appendicolith.

Ultrasound of the RLQ showing inflammation of the appendiceal wall (hollow white arrows showing fluid in the layers of the wall and sluge at the base of the appendix) and with a typical “bulls eye” in the picture on the right (showing fluid in the layers of the wall in cross section) and free fluid in the abdomen.

CT Of the abdomen with contrast. The appendix is seen dilated with a slightly thickened wall and some inflammation surrounding it.

3. Outline the pathophysiology of appendicitis. What are the risk factors (age, gender, co-morbidities)? (This requirement can be met by adding to your brochure)

4. What are the surgical options? Risks? Benefits?(on brochure)

Open Appendectomy

Laparoscopic Appendectomy

Pathologic specimen with fibrinous exudates

Histological Specimen

Expected Outcome

(on brochure)

5. What would you tell the patient to expect postoperatively? (include both acute and chronic issues)

Make a Patient Brochure for the Appendectomy patient.

Be sure to include pictures (you are not limited to the following requirements)

Pre and post-op surgical information/directions

Your office/surgical center name/location/phone number/map (directions)

Staff information

Educational information/explanations about the appendix, the pathophysiology (appendicitis- what is it?), and the surgery/technique that will be used.

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