Brad Kay & Levi Stafford

12/15/2014
Appendicitis Case Study
A 38 year old male presents with a sharp pain in the lower right quadrant of his
abdominopelvic cavity. He states he has not had a bowel movement in a three days, has a loss
of appetite, a high fever, nausea and vomiting. An abdominopelvic exam was completed and
inflammation is present. His skin felt hot and had a reddish look to it. We then perform
urinalysis on the patient. The urinalysis came back normal therefore ruling out a urinary tract
problem. A blood test was then performed and there was an increased amount of white blood
cells. Seeing that there was an abnormal amount of white blood cells we decided to look
further into this patient and order an ultrasound. The ultrasound showed an enlarged appendix
or possibly an abscess near the inferior portion of the large intestine. This leads us to believe it
might be appendicitis. Appendicitis is caused by a blockage of the vermiform appendix, usually
caused by a calcified stone made of feces. The fact that the patient hasnt had a bowel
movement in three days leads us to believe this is the etiology of the problem. However,
inflammation of lymph tissue, gallstones, tumors, or parasites could also play a part in
appendicitis. With appendicitis, blood flow to the appendix tissues are decreased while the
pressures within the appendix are increased. Inflammation starts to occur due to the growth of
bacteria within the appendix. The combination of these three homeostatic imbalances causes a
great amount of danger to tissue and possibly could lead to bursting of the appendix. This
would be detrimental to the body due to bacteria within the appendix. The bacteria would then
leak into the abdominal cavity thus increasing complications with other organs. Therefore, we

believe the appendix should be removed. We will start treatment with a prescription of
antibiotics. Zosyn is a brand name of drug that contains piperacillin (a broad spectrum, beta
lactum class antibitotic) and tazobactum (a beta lactumase inhibitor). This drug uses betalactumase enzyme inhibition to allow the antibiotic to take effect. The pathologic bacterium
presents a beta lactamase enzyme that is used to attach and destroy the beta lactum class
antibiotic. In our case this broad spectrum antibiotic (piperacillin) is not strong enough on its
own, and would be destroyed, however with the tazobactum administered it is sufficient
enough to destroy the bacteria. The Tazobactum acts by binding to the bacterias beta
lactumase binding sites, thus filling up the area that the bacteria would normally use to bind to
on the beta lactum aspect of the piperacillan. At this point the bacteria is inhibited from
binding to the piperacillin, and this binding action allows piperacillan to do its job as an
antibiotic and destroy the cell walls of the pathogenic bacteria.
Secondly we then perform an appendectomy via a laparoscopy. While in direct view of
the appendix from the three laparoscopic cameras, we will confirm appendicitis and remove it
from the body. This procedure will call for the need of anesthesia, so we need to make sure the
patient can withstand general anesthesia. After the incision is made, the surgeon will get rid of
the infected tissue and cut the appendix from the surrounding tissue. Inspection of the
surrounding tissue of the infected area will be performed very attentively and then the patient
will be stapled or stitched back together and the incision will be protected by a sterile bandage.