Case of Abdominal Pain for Medical Presentation using Digital Slides

Given a text for medical presentation and a pool of picture slides, prepare a 6-minute presentation in consideration of the requirements for clear and clean digital slides.

Case Presentation on Patient with Right Lower Quadrant Abdominal Pain

For Medical Presentation Using Digital Slides

A 25-year-old female patient consulted a physician because of abdominal pain. The pain started one day prior to consultation, initially, epigastric in location and after several hours, shifted to the right lower quadrant of the abdomen. There were no associated gastrointestinal symptoms like diarrhea, constipation, vomiting and bloatedness. There were also no symptoms of urinary disturbance, vaginal discharge and no febrile episode during this time. She had been having menses at regular intervals of 28 days with the last one being two weeks ago.

Significant physical examination findings at the time of consultation consisted of a mild to moderate direct tenderness at the right lower quadrant of the abdomen. The other physical examination findings were essentially normal.

The initial primary and secondary clinical diagnoses were acute appendicitis and mittelschmerz (ovulation pain) respectively.

A paraclinical diagnostic procedure was considered because the certainty for the diagnosis of acute appendicitis has not reached 90% and the usual recommended treatments for the primary and secondary diagnoses were markedly different. The usual recommended treatment for acute appendicitis is an operation to remove the appendix. For mittelschmerz, the usual recommended treatment is administration of analgesics.

The following table of information on the options of paraclinical diagnostic procedures was presented to the patient and her relatives with the understanding that the primary objective in doing and selecting a procedure consisted of increasing the degree of certainty on the diagnosis of acute appendicitis:

The patient and her relatives decided to go for an ultrasound of the lower abdomen. The result showed a dilated appendix. There were no unusual findings on the uterus and its adnexal organs.

With persistence of the right lower quadrant abdominal tenderness, reinforced by the finding of dilated appendix on ultrasound, a pretreatment diagnosis of acute appendicitis was decided upon at this time.

The patient and her relative were informed of the pretreatment diagnosis and were appraised of the options for treatment. The following tables of information on the options for treatment were given to them:

Between operative and non-operative treatment:

Between open and laparoscopic appendectomy:

The patient and the relatives decided on an open appendectomy.

The patient was then prepared for the open appendectomy. The following were done as part of the preparations:

• Optimization of patient’s condition with screening for any condition that will interfere with treatment

• Informed consent for operation

• Psychosocial support

• Prepare operating materials and needs

• Preoperative antibiotics

• Fasting for 6 hours

• Intravenous fluid administration

The patient was operated 8 hours after, from the time of the consultation.

A spinal anesthesia was administered by an anesthesiologist.

A transverse right lower quadrant incision was made and carried down to the peritoneum. At the abdominal musculature layer, the external oblique, internal oblique and transversus abdominis were retracted in a gridiron fashion.

Intraoperative finding showed an appendix that is ileal in direction, dilated at the distal end, with thin strips of fibrin on its serosal surface.

The preoperative diagnosis of acute appendix was confirmed with the intraoperative findings. An appendectomy was then done after mobilizing it and transecting the mesoappendix. After the appendix was transected at the base near the cecum, the stump was ligated with two silk 2-0 sutures. After a correct sponge, needle and instrument count, the abdominal incision was repaired and closed layer by layer.

Postoperatively, the patient was given analgesics to control the pain. She resumed her regular diet.

A day after the operation, she was discharged with analgesics for home medication. She was also advised on how to take care of her appendectomy wound. She was asked to follow-up with the physician one week after.

On follow-up one week after the operation, the initial complaint of right lower quadrant abdominal pain was already completely gone. The appendectomy wound was healing well. There were no signs of inflammation and infection such as erythema and purulent discharge. The patient was satisfied with the result of the physician’s management.

The final diagnosis was acute suppurative appendicitis.

The following general goals in the patient management were achieved: resolution of the health problem in such as a way that the patient does not end up dead; does not have unwarranted disability and complication; is satisfied; and there are no medicolegal issues.

Mission accomplished.

Gallery of pictures that may be used for the presentation (Students have to select and edit pictures as needed. They are free to get other pictures from the NET.):

ROJ@12jun29