8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 1/22

Prezentare de caz clinic  Coordonator dr Branescu Cristian

  Grupa 59

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 2/22

Pacientul O.A., 27 ani

Internat in serviciul sectiei IV Chirurgie !!B,in data de 2"."5.2"#$, din a%&ulator

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 3/22

Motivele internarii 

'urere in (osa iliaca dreapta

)e&ra

*eteoris% a&do%inal

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 4/22

AHC

+ese%nicative

APP

'in antecedentele &olnavului nu decela%

in(or%atii relevante

Conditii de viata, munca si mediu

+e(u%ator

Consu%a alcool oca-ional

Ali%entatie echili&rata

Pacientul este cadru %ilitar

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 5/22

Istoricul bolii

u(erinta a de&utat insidios cu 5 -ile anteriorinternarii, cu aparitia durerilor in (osa iliacadreapta.

'urerea avea initial caracter colicativ, ulteriordevenind continua, (ara po-itie antalgica.

 ran-it intestinal pre-ent, (ara tul&urari de

%ictiune

Cu 2 -ile anterior internarii, pacientul a re%arcataparitia (e&rei si intensicarea durerilor insotite de%eteoris% a&do%inal si s/a pre-entat la spital.

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 6/22

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 7/22

Aarat resirator

 orace nor%al con(or%at, si%etric, %o&il cu

respiratia, vi&ratii vocale trans%ise, *V pre-ent&ilateral, (ara raluri

)4 0 2#%in

Aarat cardiovascular

AV 0 72 &p%, -go%ote cardiace rit%ice, (arasu6uri

Aarat uro-genital

4inichi nepalpa&ili

'iure-a pre-enta

Sistem nervos

4O si%etrice &ilateral

)ara se%ne de iritatie %eningiana

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 8/22

Examen localAarat digestiv

A&do%en suplu, %o&il cu respiratia, dureros

spontan si la palpareipereste-ie cutanata

Aparare %usculara in (osa iliaca dreapta

e%n Blu%&erg pre-ent

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 9/22

!iagnostic de etaa

  Patologie acuta, posi&il apendiculara, datoritapre-entei triadei 'ieula(o8

ipereste-ie cutanata

'urere spontanaContractura %usculara

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 10/22

Investigatii araclinice  Pentru preci-area diagnosticului de certitudine si a starii &iologice a

pacientului a% considerat necesare ur%atoarele e:plorari paraclinice

e%oleucogra%a

u%ar de urina

Biochi%ieGlice%ie

Creatinina serica

!ree

 ransa%ina-e

A%ila-a serica

Biliru&inaCoagulogra%a

;3g

4adioscopie pul%onara <pentru conditii intraoperatorii=

;cograe a&do%inala <de&ut al &olii ase%anator cu o patologie &iliara litia-ica=

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 11/22

!iagnostic ozitiv

Apendicita acuta

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 12/22

!iagnostic di"erential

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 13/22

!iagnostic di"erential!lcer peptic per(orat

'iverticulita acuta a diverticulului *ec3el

;nterita acuta regionalaOclu-ia intestinala

Colecistita acuta

Pancreatita acuta

Pielone(rita acuta dreapta>itia-a ureterala

ernie inghinala sau inghino/scrotala

Patologie herpetica <-ona -oster=

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 14/22

Comlicatii osibileApendicita per(orata

Gangrena

Peritonita locali-ata <plastron apendicular=

Peritonita di(u-a

A&ces periapendicular

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 15/22

Tratament

Anti&ioterapie prolactica pe cale iv

< Ce(alosporine generatia a II/a sau a III/a=

Chirurgical <clasic sau laparoscopic=

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 16/22

Tratament c#irurgical

In acest ca- s/a ales interventia clasica, cuinci-ie in (osa iliaca dreapta.

Pregatire preoperatorie %ini%a cu restrictieali%entara si lichidiana cu #2 ore inaintea

operatiei, cu toaleta generala si locala, (araclis%a.

Consi%ta%ant in(or%at al pacientului

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 17/22

e incearca evitarea accidentelor in legatura cuhe%osta-a , respectand principiile de prote?are aca%pului operator in %o%entul e(ectuariiapendicecto%iei pentru a nu conta%ina le-iuneasi ca%pul operator.

Instru%entarul necesar este %ini%.

Piesa recoltata se va supune unui e:a%enhistopatologic dupa prelevare in conditiistandard.

Interventie de durata scurta/%edie <"/@" %in=.

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 18/22

Aendicita acuta

$asect intraoerator%

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 19/22

Evolutie )avora&ila, cu ur%arirea

tarii generale

 ensiunii arteriale

)recventei respiratorii

Alurii ventriculareAspectului local <pansa%ent, plaga=

4eluarii tran-itului intestinal

'iure-ei

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 20/22

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 21/22

Va %ultu%i%

8/16/2019 Caz Clinic xs(4)

http://slidepdf.com/reader/full/caz-clinic-xs4 22/22