Triana Morales Daniela 1106102 HSI

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Triana Morales Daniela -1106102 HSI

• Antecedentes
• Menarquia 24-12-03
• U.Menstruación 24-12-03
• Talla145cm, P38 kg,Dolor a la palpación fosa
  iliaca izquierda (repisado). Blumberg -
• No irritación peritoneal .Rs Intestinales
• Dx Dolor abdominal en observación
• Gastroenteritis
• Deshidratación I
• SS Hidratación parenteral.
• 24-02-04(0430) Abdomen difícil de valorar por
  emesis y paciente álgida.
• 0700 Valoración por Cirugía para programar
  laparotomía.

• F.I24-02-04
• FS27-02-04
• Edad 12 años
• Consulta a Urgencias por dolor abdominal en
  hipogastrio, nauseas, vomito, y deposiciones
  liquidas de 30 horas de evolución.
• FI a Urgencias 23-02-04 (1930)
• Toman CH 19.800 leuc.
• N92, L8 No hay interpretación.

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Triana Morales Daniela -1106102 HSI

• 24-02-04
• H. Clinica de Ingreso La madre suministró
  Buscapina e interpretan Cuadro Hematico como
  infeccioso-inflamatorio

• 24-02-03 (0930)
• Laparotomia
• Apendicitis gangrenosa
• peritonitis generalizada.
• Clindamicinaamikacinaampicilina
• Salida control
• Drenaje absceso de pared el dia 05-03-04

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Triana Morales Daniela -1106102 HSIno
conformidad

• La madre presenta queja por demora en la Cirugía.

• Análisis
• Hora de Ingreso
• 23-02-04 1930
• Hora cirugía
• 24-02-04 0930
• Tiempo13 horas
• Usualmente por ayuno / otras 7 horas
• Causas de Dx tardío
• Automedicación con analgésicos Antiespasmódicos

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Clinical Considerations Typical Clinical
Presentation Appendicitis initially produces
crampy periumbilical pain, corresponding to
infection localized to the appendiceal mucosa and
muscularis layers. Pain then becomes more
localized to the region of the appendix as
infection extends into the peritoneal layer.
Anorexia, nausea, vomiting, fever, and
leukocytosis (with left shift, no eosinophilia)
are common.
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Clinical Considerations Atypical Clinical
Presentation A. Atypical clinical presentation
related to the position of the appendix The
incidence of atypical clinical presentation of
appendicitis ranges from 30 - 45 (4). The
relationship of the base of the appendix to the
cecum is generally constant. However, the
position of the distal end of the appendix is
variable. It may be found in a medial, lateral,
or caudal position with respect to the cecum, or
may be retrocecal. Two thirds of appendices are
retrocecal in location only one third extend in
an inferomedial direction (9).
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Retrocecal or retroileal appendix A child with
acute retrocecal or retroileal appendicitis
(appendix deep to distal ileal bowel loops) may
walk with exaggerated lumbar lordosis and have a
slightly flexed right hip as a result of right
psoas muscle spasm. Pain with extension of the
right hip with the patient in left lateral
decubitus position (psoas sign) and with internal
rotation of the thigh (obturator sign) may be
found with retrocecal appendicitis. If present,
this indicates peritonitis
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Clinical Considerations Outcome The
preoperative clinical diagnostic accuracy rate
ranges from 70 - 78, with an unnecessary
laparotomy rate of 20 - 25 (4,10,11). This rate
is higher in women at 35 - 45 (13). Perforation
occurs in 20 - 40 of patients with appendicitis
(8,12) . In children, if the diagnosis is delayed
for more than 36 hours, the perforation rate is
65 (2).
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CLINICAL AND DIAGNOSTIC IMAGING CORRELATES IN
APPENDICITIS IN CHILDREN A Computer Aided
Teaching Program A Vade MD, CG Salomon MD , CL
Kalbhen MD, JR Halama PhD Loyola University
Medical Center, Maywood, Illinois
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Buscapina

• Composición Inyectable cada ampolla de 1 ml
  contiene Escopolamina N-Butil Bromuro 20 mg.
• Grageas cada gragea contiene Escopolamina
  N-Butil Bromuro 10 mg. Supositorios cada
  supositorio contiene Escopolamina N-Butil
  Bromuro 10 mg. Gotas cada 1 ml (20 gotas)
  contiene Escopolamina N-Butil Bromuro 10 mg.
  Acción Terapéutica Antiespasmódico

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invima

• 2.1.1 BUSCAPINA COMPOSITUM NF COMPRIMIDOS
  RECUBIERTOS
•  
• EXPEDIENTE 36345
•  
• INTERESADO Boehringer Ingelheim S.A.
•  
• FORMA FARMACÉUTICA
•  
• Comprimidos recubiertos.
•  
• COMPOSICIÓN
•  
• Cada comprimido contiene n-butilbromuro de
  hioscina 10 mg, paracetamol (acetaminofén) 500
  mg.
•  
• INDICACIONES
•   Analgésico, antipirético, antiespasmódico.
•  
• CONTRAINDICACIONES Y ADVERTENCIAS
•  

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• Drugs withdrawn from the market Buscapina, an
  unapproved drug that came from Mexico, appeared
  to be the pain and fever drug dipyrone. The FDA
  removed dipyrone from the market in 1977 because
  of potentially fatal side effects

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• Children
• Children with appendicitis are misdiagnosed in
  25-30 of cases overall, and the rate of initial
  misdiagnosis is inversely related to the age of
  the patient.
• The most common misdiagnosis is gastroenteritis,
  followed by upper respiratory infection and lower
  respiratory infection.
• Misdiagnosed children are more likely than their
  correctly diagnosed counterparts to have vomiting
  before pain onset, diarrhea, constipation,
  dysuria, signs and symptoms of upper respiratory
  infection, and lethargy or irritability.
• Physical findings less likely to be documented in
  the children who are misdiagnosed include
  findings of ear, nose, and throat exam bowel
  sounds peritoneal signs and findings of rectal
  examination