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Good morning I’m Clinical Clerk Lenard Bangug I am here to discuss a case of a 10 year old

male from Quezon City who came in with a chief complaint of abdominal pain. History started
1 day prior to admission, patient had generalized crampy abdominal pain, non radiating
graded 7 out of 10 accompanied by 1 episode of vomiting of previously ingested food, non
bilious, non projectile. Patient self medicated with Buscopan which afforded partial relief. oo
fever, dysuria, hematuria, nor diarrhea were noted at this time. 7 hours prior to admission,
patient had right lower quadrant pain graded 4/10, aggravated by coughing with loss of
appetite and undocumented fever. Patient sought consult with a private pediatrician. CBC and
urinalysis were requested. CBC results showed an elevated WBC count of 20.5. Urinalysis
showed 0-2 red blood cells and 3-7 pus cells per high power field. Assessment at this time
was acute appendicitis. Patient was referred to PCMC however preferred to transfer to USTH.
For the past medical history, our patient is allergic to seafood and eggs; Review of systems was
unremarkable. Patient had no cough nor colds. (This is important to note because In pediatric patients
Acute mesenteric adenitis is most often confused with acute appendicitis in children Almost always an
URTI is present or has subsided. Pain is usually diffuse & tenderness is not as sharply localized;
Relative lymphocytosis; self limited disease) ; For the Family history, the patient’s maternal aunt had
lymphoma. Physical Examination on admission, patient was conscious, coherent not in distress mildly
dehydrated, limping, with a blood pressure of 110/70, tachycardic with a heart rate of 121 beats per
minute, tachypneic with a respiratory rate of 21, and febrile with a temperature of 37.8 degrees
Celsius. Patient had pink palpebral conjunctiva, dry lips, non hyperemic posterior pharyngeal wall,
symmetrical chest expansion, and clear breath sounds. The abdomen was flabby, soft, normoactive,
dull on all quadrants. There was positive direct and rebound tenderness on the right lower quadrant
as well as positive rovsing, Dunphy, psoas, and obturator signs. The Alvarado score of our patient was
9. (Migratory right iliac fossa pain 1, anorexia 1, vomiting 1, tenderness right iliac fossa 1, fever
greater than 36.3 1, leukocystosis 2 ; No shift to the left of neutrohpils; DRE – positive pararectal
tenderness; Pulses were full and equal with a capillary refill time of less than 2 seconds) Our admitting
diagnosis was acute appendicitis. On admission, our Patient was placed on NPO, IV fluids were
started. Plain NSS 1 L at 120 cc per hour. Patient was started on cefoxitin 2 grams per IV followed by
cefoxitin 1 gram per IV every 8 hours. Our Patient was also given paracetamol 300 mg/hour every six
hours for his abdominal pain. Our patient underwent laparoscopic appendectomy. Postoperative
diagnosis was acute suppurative appendicitis. On laparoscopy, the patient appendix was dilated
measuring 8 by 1 cm in its suppurative state. The base was intact, no appendicoloith noted. There was
minimal serous peritoneal fluid at the RLQ. Post operatively, patient was asleep, comfortable, with
stable vital signs blood pressure of 110/70, HR 73, T 36.5, RR 18, SPO@ 98, dry lips clear breath
sounds, abdomen flabby soft non tender good pulses, no bleeding at post op site. Post op the patient
was given omeprazole 20 mg/iv once a day while in NPO and Cefoxitin 1 gram per iv every 8 hours.
(useful for treatment of infections below the diaphragm. have reasonable activity against gram
negatives and anaerobes, including B. fragilis, and are commonly used for intra-abdominal surgical
prophylaxis and infections) and IVF D5LR 1 L to run at 75-76 CC/hr. (Feb 18) s/p lap. Ap. Abdomen
was soft non tender. The abdomen drapings were dry. Patient had clear to general liquids diet.
Cefoxitin and omeprazole were continued. The indwelling catheter was removed Day 1 post op our
patient had good oral fluid intake, ambulatory, and minimal post op pain. Patient had flatus and
bowel movement. Patient had Stable vital signs BP 100/70 PR 80 RR 17 T 36.6 clear breath sounds,
abdomen was soft non tender. patient was also voiding freely at this time. Patient was shifted to soft
diet. Today patient able to tolerate soft diet. Bowel movement of 3 times. Patient stable vital signs.
Patient had no abdominal pain, abdomen soft non tender full pulses. Cefoxitin was shifted to
cefuroxime 500 mg/tab 1 tab every 12 hours (adult dose).