dr_messo
31-03-2002, 05:47 PM
F S A 17 year old school student Saudi male patient admitted to the hospital through E.R 5 days ago complaining of 4 days history of right iliac pain & swelling also fever some times .
History of Presnting Illness :
Abdominal pain :
The patient was well 5 days prior to admission but after break fast start to have vomiting then pain and swelling gradually .
· Right iliac fossa .
· Gradual onset .
· Continuous 4 days with the same rhythm .
· Not so sever ( 7/10 ) .
· Dull pain .
· Not radiating .
· Icreased with food intake .
· Relived by grugs .
· Associated with swelling & anorexia & vommiting after pain & fever some times for about half an hour duration .
Swelling :
· gradual
· 4 days
· ovale
· painful
· لا icreasing or decreasing in size .
Vomiting:
· just at 1st day after pain .
· 3 times with about 1 hour inbetween each attack .
· لا projectile .
· about 1\2 cup .
· its color is close to color of food wich he takes .
** no H/O diarrhea constipation or change in bowel habits , heart burn , odynophagia , bleeding , hematemesis jaundice , melena or hematechezia .
Past medical history :
· No history of previous hospital admission , D.M , HTN , T.B , rheumatic fever , surgery , or ischemic heart disease .
Medication :
· No H/O chronic medications .
Allergies :
· No H/O drug , food , animal or occupational allergy .
Social history :
· Single , school student , grade 8 .
· Living with his family in owened building .
· No H/O smoking, alcohol or drug abusing .
Family history :
· No family history of HTN , DM , C.V.A , ischemic heart disease , asthma , malignancy or death of young relatives .
Review of systems :
· NO SIGNIFICANT SYMPTOMS .
On examination:
· The patient was conscious , cooperative , oriented to time, person & place .
· Look well , mormal body built , ling comfortably on bed .
· Not jaundice , cyanosed .
· Afebrile .
· Vitals :
o P.R = 85 /min . regular , normal volume , no femoral delay , collapsing pulse ,syncronus also blood vessel wall was لا palpable .
o R.R = 16/ min .
o B.P = 110 / 70 mmHg .
o Temp. = 36.9 C .
· Head :
o Eyes were normal no pallor or jaundice .
o Tounge was normal , no central cyanosis or abnormal coloration .
o Lips were also normal color , no perephral cyanosis .
· Neck :
o No lymph node enlagment , normal J.V.P , normal thyroid , normal carotid , trachea was لا displaced .
· Hands :
o No clubbing , leuconychia , koilonychias , splinter hemorrhage , palmar erythema , tremor , waisting , swilling or deformity .
· G.I.T :
o Swelling in the right iliac fossa
· This swelling is :
· Single
· Ovale
· About 4-5 cm
· No discoloration
· Smooth surface
· Tenderness
· Ill defined edge
· Not pulsatile
· Little hot
· Not flactuant
· Skin over it can move freely
o No, promenant veins , hernia scar , scrach mark , hair distribution , pigmentation , rigidity , organomegaly or ascitis .
o Normal liver span , spleen was لا palpable .
o No other significant ( remarkable )findings .
Investegations :
· CBC shows elevated WBCs ( 13,000 )
· Rised serum amylase .
· ULTRASOUND shows enlarged appendix .
_______________
waiting for ur openions
& quistions
thx all
History of Presnting Illness :
Abdominal pain :
The patient was well 5 days prior to admission but after break fast start to have vomiting then pain and swelling gradually .
· Right iliac fossa .
· Gradual onset .
· Continuous 4 days with the same rhythm .
· Not so sever ( 7/10 ) .
· Dull pain .
· Not radiating .
· Icreased with food intake .
· Relived by grugs .
· Associated with swelling & anorexia & vommiting after pain & fever some times for about half an hour duration .
Swelling :
· gradual
· 4 days
· ovale
· painful
· لا icreasing or decreasing in size .
Vomiting:
· just at 1st day after pain .
· 3 times with about 1 hour inbetween each attack .
· لا projectile .
· about 1\2 cup .
· its color is close to color of food wich he takes .
** no H/O diarrhea constipation or change in bowel habits , heart burn , odynophagia , bleeding , hematemesis jaundice , melena or hematechezia .
Past medical history :
· No history of previous hospital admission , D.M , HTN , T.B , rheumatic fever , surgery , or ischemic heart disease .
Medication :
· No H/O chronic medications .
Allergies :
· No H/O drug , food , animal or occupational allergy .
Social history :
· Single , school student , grade 8 .
· Living with his family in owened building .
· No H/O smoking, alcohol or drug abusing .
Family history :
· No family history of HTN , DM , C.V.A , ischemic heart disease , asthma , malignancy or death of young relatives .
Review of systems :
· NO SIGNIFICANT SYMPTOMS .
On examination:
· The patient was conscious , cooperative , oriented to time, person & place .
· Look well , mormal body built , ling comfortably on bed .
· Not jaundice , cyanosed .
· Afebrile .
· Vitals :
o P.R = 85 /min . regular , normal volume , no femoral delay , collapsing pulse ,syncronus also blood vessel wall was لا palpable .
o R.R = 16/ min .
o B.P = 110 / 70 mmHg .
o Temp. = 36.9 C .
· Head :
o Eyes were normal no pallor or jaundice .
o Tounge was normal , no central cyanosis or abnormal coloration .
o Lips were also normal color , no perephral cyanosis .
· Neck :
o No lymph node enlagment , normal J.V.P , normal thyroid , normal carotid , trachea was لا displaced .
· Hands :
o No clubbing , leuconychia , koilonychias , splinter hemorrhage , palmar erythema , tremor , waisting , swilling or deformity .
· G.I.T :
o Swelling in the right iliac fossa
· This swelling is :
· Single
· Ovale
· About 4-5 cm
· No discoloration
· Smooth surface
· Tenderness
· Ill defined edge
· Not pulsatile
· Little hot
· Not flactuant
· Skin over it can move freely
o No, promenant veins , hernia scar , scrach mark , hair distribution , pigmentation , rigidity , organomegaly or ascitis .
o Normal liver span , spleen was لا palpable .
o No other significant ( remarkable )findings .
Investegations :
· CBC shows elevated WBCs ( 13,000 )
· Rised serum amylase .
· ULTRASOUND shows enlarged appendix .
_______________
waiting for ur openions
& quistions
thx all