Appendisitis Akut

By : dr. Ariane N. Rahmadhani

Supervisor : dr. Winoto Hardjolukito Sp.B
Patient Identity

• Name : Ms. Dita Yuliana

• Birth Date : Jakarta, March 13th 1998
• Age : 20 years, 4 months and 28 days
• Gender : Female
• Address : Kramat Jaya, Johar baru, Center Jakarta
• Nationality : Indonesia
• Religion : Islam
• Date of admission : August, 10th 2018
• Date of examination : August, 15th 2018

2
History Taking

Auto anamnesis from patient on August 10th 2018.

• Chief Complaint
Lower right abdominal pain since a week
• Additional Conplaint
Fever, nausea, pain when urinating

3
 History of Present Illness

A 20 year old woman complained of lower right abdominal

pain since 1 week before entering the hospital, pain spread
around the navel, weighing since 1 day, then the pain felt
continuously. Fever from 1 day, the patient also complained
of nausea, without vomiting, and pain during urination.
Defecate smoothly. The patient didn’t take any medicine
before. Patients have never felt the same complaint before.

4
History of Past Illness

◉ No specific illness

5
Family History

◉ No specific illness

6
Physical Examination

• Date : August, 10th 2018

• General status
○ General condition : mild ill
○ Awareness : compos mentis
○ Blood pressure : 104/68
○ Pulse : 117 x/min, regular, full,strong.
○ Breathing rate : 22 x/min
○ Temperature : 37,5oC (peraxilla)

7
 Systematic Physical Examination
Normachephaly, hair ( black, normal distribution, not easily removed), sign of
Head
trauma (-)
Icteric scelera -/-, pale conjunctiva -/-, hyperaemia conjunctiva -/-, lacrimation
Eyes -/-, sunken eyes -/-, pupils 3mm/ 3mm isokor, direct and indirect light
response ++/++
Ears Normal shape, no wound, no bleeding, no secretion serumen
Mouth
• Lips Dry
• Teeth No carries
• Mucous Moist
• Tongue Not dirty
• Tonsils T1/T1, No hyperemia
• Pharynx No hyperemia

Neck Lymph node enlargement (-)

8
Thorax
• Inspection Symmetric when breathing,no retraction, ictuscordis is not visible
• Palpation Mass (-)
• Percussion Sonor on the lungs
• Auscultation
- Cor Regular S1-S2, murmur (-), gallop (-)
- Pulmo Vesicular +/+, Wheezing -/-, Rhonchy -/-

Abdomen
Normal
• Inspection
Supple, liver and spleen not palpable, tenderness (-)
• Palpation
The entire field of tympanic abdomen, shifting dullness (-)
• Percussion
Bowel sound 15 times/min
• Auscultation

Anus Not inspected

Extremities Warm, capillary refill time < 2 second, edema (-)

Skin Good turgor

9
Laboratory Investigation
Hematology Results NormalValue
Haemoglobin 9,8g/dL 11,7– 15,5g/dL
Leukocytes 22.78/µL 3,600 – 11,000/µL
Hematocrits 29 % 35 – 47 %
Trombocytes 244.000/µL 150,000– 440,000/µL
Erythrocytes 4.11million/µL 3,80– 5,20million/µL

Bleeding Time 1.30minute 1.00-3.00

Clotting Time 4.30minute 4.00-6.00
Blood Glucose 122 70-200
HBsAg (-) Negative 10
Emergency Diagnosis

◉ Abdominal pain susp. Acute Appendicitis

11
Emergency Treatment

◉ IVFD Asering/12hr
◉ Ketorolac 1 amp
◉ Ondancentron 1 amp

12
Follow Up
August, 10th 2018 – August, 15th 2018
@ Marwah Atas

13
August, 11th 2018

S Abdominal pain post laparotomy (VAS : 5)

General condition: Compos mentis
O Blood pressure: 100/70, pulse: 90 bpm, respiratory rate: 22
x/min, temperature: 37,0oC

A Acute appendicitis
Consultation dr. Winoto Sp.B
• Ceftriacon 2x2gr
P • Ketorolac 3x1
• Metronidazole 3x500mg
• NGT – streamed and fasting 14
Augusut, 12th 2018

S Abdominal pain (VAS : 3)

General condition: Compos mentis
O Blood pressure: 100/70, pulse: 90 bpm, respiratory rate: 22
x/min, temperature: 37,0oC

A Acute appendicitis
Consultation dr. Winoto Sp.B
• Ceftriacon 2x2gr
P • Ketorolac 3x1
• Metronidazole 3x500mg
• NGT 15
August, 13th 2018

S Abdominal pain (VAS : 2)

General condition: Compos mentis
O Blood pressure: 100/70, pulse: 90 bpm, respiratory rate: 22
x/min, temperature: 37,0oC

A Acute appendicitis
Consultation dr. Winoto Sp.B
• Ceftriacon 2x2gr
P • Ketorolac 3x1
• Metronidazole 3x500mg
• NGT 16
August, 14th 2018

S Abdominal pain (VAS : 2)

General condition: Compos mentis
O Blood pressure: 100/70, pulse: 90 bpm, respiratory rate: 22
x/min, temperature: 37,0oC

A Acute appendicitis
Consultation dr. Winoto Sp.B
• Ceftriacon 2x2gr
P • Ketorolac 3x1
• Metronidazole 3x500mg
• NGT 17
August, 15th 2018

S Abdominal pain (VAS : 2)

General condition: Compos mentis
O Blood pressure: 100/70, pulse: 90 bpm, respiratory rate: 22
x/min, temperature: 37,0oC

A Acute appendicitis
Consultation dr. Winoto Sp.B
• Ceftriacon 2x2gr
P • Ketorolac 3x1
• Metronidazole 3x500mg
• NGT 18
Literature Review

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Is the color of gold, butter and
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Blue
Is the colour of the clear sky
and the deep sea. It is located
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the optical spectrum.
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Is the colour of the clear sky
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between violet and green on
the optical spectrum.
Red
Is the color of blood, and
because of this it has
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Is the color of blood, and
because of this it has
historically been associated
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Special thanks to all the people who made and

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