Dificultades en atención de Apendicitis Aguda en atención Primaria de Salud

Abstract

Introduction: Acute appendicitis, described since 1886, is the most common abdominal emergency in the world with an incidence of 11 cases per 10,000 per year. It is the acute inflammation of the vermiform appendix obstruction of light by fecaliths or hypertrophy of the mucosa-associated lymphoid tissue; also it includes twisting or section of the appendicular artery obstruction tumors and parasites. Its diagnosis is based on a complete medical history focused on the evolution of pain and associated symptoms; and the findings during the physical examination, the pain is described acute onset and initially located epigastric or periumbilical level, anorexia, followed by nausea, vomiting and migration of pain to the right iliac fossa, besides presenting febrícula tachycardia, peristalsis and decreased pain McBurney point. Consideration should be given the location of the appendix and the time elapsed since the onset of pain and the proper interpretation of the complementary exams.

Development: This case corresponds to a male patient, 21 years old, single, mixed race, born and resident Cevallos Cevallos, Tungurahua, without personal or surgical history; which goes to Quero Health Center, where he received primary health care in the emergency service where according record 008, presented abdominal pain of about 24 hours of evolution associated with vomiting and malaise. At physical examination TA 100 / 60mmHg Fc: 80 lpm, FR: 18 rpm sat02: 96% soft abdomen, painful depressible epigastric, increased RHA gastritis (K29) administering presumed: Ranitidine IV (intravenous) STAT (that time) , butylscopolamine IV STAT and discharged home, partly giving pain for 24 hours. (Hauling difficulties in the timely and early diagnosis of acute appendicitis).

This table is exacerbated by which attends private physician who performs a detailed anamnesis referring crampy abdominal pain located in epigastrium radiating to the right iliac fossa of 48 hours of evolution, in addition to referring 8 vomiting nutritional content, it is done abdominal ultrasound report: Gallbladder: exploration painful measures 72 x 34 mm with a 3.6 mm wall thickened and presence of various calculations that measure on average 6 mm thick inside. not painful right iliac fossa exploration with the presence of complex image and thickened appendix 13 mm thick, accompanied by a volume collection has about 67cc.

Conclusions: Appendix and appendicular plastron more colecistitis- cholelithiasis so attend Provincial Teaching Hospital surgical Ambato for immediate resolution.