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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