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CPC 1
18 year old girl .2days h/o abdominal
pain,nausea,vomiting anorexia,headache,malaise.
Dull aching pain,continuous,with a more centrallocation around umbilicus.shifting to right lower
quadrant.vomiting greenish material since
morning.low grade fever.
Differential diagnosis of generalised abdominal
pain in a young female?
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Physical examination findings
Tenderness right lower quadrant.
Guarding of the abdomen
Rebound tenderness
Positive Rovsings test
Positive psoas sign
Positive obturator sign Right sided tenderness
Likely diagnosis?
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explain
What is the reason for shift in
tenderness from periumbilical to right
lower quadrant
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define
Inflammation.acute inflammation
Major vascular events in acute
inflammation
Five classical signs of local inflammation
Chemical mediators in inflammation
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This appendix was removed surgically. Thepatient presented with abdominal pain that initiallywas generalized, but then localized to the rightlower quadrant, and physical examinationdisclosed 4+ rebound tenderness in the right lowerquadrant. The WBC count was elevated at 11,500.Seen here is acute appendicitis with yellow to tan
exudate and hyperemia, including theperiappendiceal fat superiorly, rather than asmooth, glistening pale tan serosal surface.
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Here is the resected appendix from
laparoscopic surgery. Note that there is
some tan-yellow exudate, but the mainfeatures of this early acute appendicitis are
edema and hyperemia.
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Gross pathology
Fig 2.40.currans atlas
Fig 15.42 Robbins
Keep specimens from our institution(both
wet and mounted)
Student to describe what is seen
Keep record of the exercise
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explain
Cells involved in acute inflammation
Margination,adhesion,transmigration,chemo
taxis
Histology of appendix(keep slides and
images so that the student can see them )
Peripheral leucocytosis in this patient.
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Treatment
Treatment of choice
Complication of acute appendicitis
Complications of surgical interventions
Complications if surgical intervention is not
done or delayed