INTRODUCTION

Acute appendicitis can occur when a piece of food, stool or object becomes trapped in the appendix, causing irritation, inflammation, and the rapid growth of bacteria and infection. Acute appendicitis can also happen after a gastrointestinal infection. Rarely, a tumor may cause acute appendicitis. Sometimes the cause of acute appendicitis is not known. The inflammation is usually caused by a blockage, but may be caused by an infection. Without treatment, an inflamed appendix can rupture, causing infection of the peritoneal cavity (the lining around the abdominal organs) and even death.

STATISTICS
Appendicitis is one of the most common causes of emergency abdominal surgery. Up to 75,000 appendectomies are done each year n the U.S. The estimated population in the Philippines is 862,416,972 and the incident rate of acute appendicitis is 215,604 as of year 2011. In the United States, 250,000 cases of appendicitis are reported annually, representing 1 million patient-days of admission. The incidence of acute appendicitis has been declining steadily since the late 1940s, and the current annual incidence is 10 cases per 100,000 populations. Appendicitis occurs in 7% of the US population, with an incidence of 1.1 cases per 1000 people per year. Some familial predisposition exists.

PROGNOSIS
Most appendicitis patients recover easily with surgical treatment, but complications can occur if treatment is delayed or if peritonitis occurs. Recovery time depends on age, condition, complications, and other circumstances, including the amount of alcohol consumption, but usually is between 10 and 28 days. For young children (around 10 years old), the recovery takes three weeks. The real possibility of life-threatening peritonitis is the reason why acute appendicitis warrants speedy evaluation and treatment. The patient may have to undergo medical evacuation. Appendectomies have occasionally been performed in emergency conditions (i.e., outside of a proper hospital), when a timely medical evaluation was impossible.

ASSESSMENT

HEALTH HISTORY AND REASONS OF ADMISSION A case of patient X 13 years old male, living in Liloan, Cebu City. A Filipino citizen and Roman Catholic. Patient was born on August 24, 2000. His father's name is Alberto Ponce and mother's name Aurilla Capangpangan. Patient was admitted last Nov 16, 2013.

One month prior to admission patient X was controlling or holding urge to defecate because of contaminant water . One week prior to admission with aggravation of symptoms. Upon admission patient is pallor in skin color.

Vitals signs upon admission are as follows: Temperature: 36.4 C Pulse rate: 90 Respiratory rate: 24 Blood pressure: 90/60

PAST MEDICAL AND SURGICAL HISTORY Patient X have experiencing UTI when he was 2 yrs. old and He also had history of surgery left lower extremities.

FAMILY, PSYCHOSOCIAL AND PERSONAL HISTORY

Pt. X is a male, was born on August 24, 2000 in Bamban Tarlac. He is a Filipino citizen, currently living in Liloan Cebu City. He is the youngest in the family. He is a grade six student at Consolacion Elementary School. Pt. stands 45, weight 37 lbs. Patient is still a student. Patient's usual activities include watching television in the house with his brothers. Patients reports no signs of boredom at home. Patient sleeps 8-9 hours every night.

Pt's X's family health history: Diabetes and hypertension

GENERAL APPEARANCE: Patient received sitting on bed, awake and conscious. Patient's body built is skinny. Patient was accompanied by his father.
ASSESSMENT FINDINGS: SKIN Patient has moderate light skin color with good skin turgor. Patient does not have any lesions, sores, bruises and insect bites but it has an surgical scar. Skin was dry, rough in texture and a tenderness on posterior left arm upon palpation. NAILS Patient's hand and feet nails , has a round shape with capillary refill of lesser than three seconds. Patient has no irregularities and no evidence of biting but his nails were not clean. HAIR

Upon inspection, patient has black, thin and evenly distributed. No infestations on axilla, and extremities were noted but presence of dandruff and scar on head.

HEAD AND NECK Upon inspection, face and skull were symmetrical. Closed suture lines and fontanels both anterior and posterior. Patient were able to blink without any discomfort. Has a good neck hygiene without evidence of rash and irritation noted. Has no signs of swollen lymph nodes noted and non palpable thyroid. Patient has symmetrical trachea. Neck muscles and head movement were intact. No nodules were noted and non palpable.
EYE AND VISION Upon inspection, patient has symmetrical aligned eyebrows, eyelashes and eyelids. Conjunctiva is pale without any discharges. Pupil size is equal with measurement of 5mm to the right and left eye. Reactions to light in both eyes are brisk and uniform constriction. Visual acuity is grossly normal. EAR AND HEARING The patient's auricle is properly aligned with the outer canthus of the eye while his pinna recoils after it is folded. There are no lesions, nor masses noted, nor obstruction of the cerumen in the ear canal. NOSE AND SINUSES Upon inspection, the patients nose was uniform in color with the face. There were no nasal flaring and lesions noted. Both nares are patent. No evidence of discharges or any obstructions were noted and assessed. A non palpable ethmoid, maxillary, frontal and sphenoid. MOUTH AND THROAT Upon inspection, patient's lip is pallor in color and with evidence of dryness noted. Patient has dental carries both upper and lower teeth are complete. Gums and tongue are pinkish in color and can move freely without any discomfort.

BREAST AND THORAX The patient has no small extra nipple noted, odorless and no evidence of lumps. Patient chest expansion was symmetrical in both inspiration and expiration. Patient has vesicular sound on both lung field upon percussion. ABDOMEN Upon inspection, the pt. have lesions noted in abdomen area because of the surgical incision . There is growling sound (borborygmy) upon auscultation. Tympanic sound heard upon percussion. Patient has tenderness on right lower quadrant and left lower upon palpation because of full bladder. RECTOANAL AREA Patient refused to be assessed but stated he has no problems within recto anal area. GENITALIA Patient refused to be assessed but stated he has no problems within his genitalia.

MUSCULOSKELETAL SYSTEMS Upon inspection, patient has no rashes but scars noted on left lower extremities . No evidence of lumps noted. Patient has no dislocation noted on hips. No evidence of kyphosis, scoliosis and lordosis.
NEUROLOGICAL EXAMINATION Patient is awake, alert and fully oriented. Patient's memory is intact both recent (able to recall date of admission). Patient has normal speech pattern, no slurring of speech with words clear and comprehensible. Patient's posture is slightly head forward. Patient's facial expression seem happy and comfortable. AUTOMATIC REFLEXES Patient's both eyes were able to blink due to loud noise and bright light. Patient's palmar grasp is intact.

LABORATORY

Name: Patient X Age: 13 years old Gender: male Pt. ID: 512601-2013 Sample ID: 13802551 Date/Time rendered: 11/17/13 ; 6:45am Date/Time received: 11/17/13 ; 8:55am Physician: Dr. Danilo JR.

URINALYSIS
COLOR: YELLOW APPEARANCE: SLIGHTLY HAZY SPECIFIC GRAVITY: 1000 PH: 9.0 (ABOVE NORMAL) PROTEIN: (-) GLUCOSE: (-) RBC: 0-1 WBC: 1-3

HEMATOLOGY

RESULT

UNIT

REFERENCE

COMPLETE BLOOD COUNT WBC COUNT 13.12 10^g/L 4-8-10.8 ( above normal limit signify infection) 110-180 (normal)

HEMOGLOBIN

123

g/L

HEMATOCRIT
MCV MCH RBC COUNT

0.34
75.60 27.00 4.55

L/L
fl Pg 10^12/L

0.42-0.52 (Below normal)

80-94 (Below normal) 27-31 (normal) 4.70-6.10 (below normal limit signify anemia)

MCHC
RDW

358
12.90

g/L
%

330-370 (normal)
11-16 (normal)

Differential Count NEUROPHIL

RESULT 72.10

UNIT %

REFERENCE 40-74 (NORMAL)

LYMPHOCYTE
MONOCYTE EOSINOPHIL BASOPHIL STAB ATYPICAL LYMPHOCYTE METAMYELOCYTES MYELOCYTES BLAST

22.50
4.80 0.40 0.20 0 0 0 0 0

%
% % % % % % % %

19-28 (NORMAL)
3-9 (NORMAL) 0.7 (ABOVE NORMAL) 0-2 (BELOW NORMAL)