caz clinic xs(4)
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8/16/2019 Caz Clinic xs(4)
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Prezentare de caz clinic Coordonator dr Branescu Cristian
Grupa 59
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Pacientul O.A., 27 ani
Internat in serviciul sectiei IV Chirurgie !!B,in data de 2"."5.2"#$, din a%&ulator
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Motivele internarii
'urere in (osa iliaca dreapta
)e&ra
*eteoris% a&do%inal
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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
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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.
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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
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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
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!iagnostic de etaa
Patologie acuta, posi&il apendiculara, datoritapre-entei triadei 'ieula(o8
ipereste-ie cutanata
'urere spontanaContractura %usculara
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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=
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!iagnostic ozitiv
Apendicita acuta
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!iagnostic di"erential
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!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=
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Comlicatii osibileApendicita per(orata
Gangrena
Peritonita locali-ata <plastron apendicular=
Peritonita di(u-a
A&ces periapendicular
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Tratament
Anti&ioterapie prolactica pe cale iv
< Ce(alosporine generatia a II/a sau a III/a=
Chirurgical <clasic sau laparoscopic=
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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
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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=.
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Aendicita acuta
$asect intraoerator%
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Evolutie )avora&ila, cu ur%arirea
tarii generale
ensiunii arteriale
)recventei respiratorii
Alurii ventriculareAspectului local <pansa%ent, plaga=
4eluarii tran-itului intestinal
'iure-ei