Infections of the gastro-intestinal tract

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Appendicitis

Case report:

A 24 year old student appears in practice and complains of repeatedly for a week and increasingly occurring abdominal discomfort. In recent days, these pains have localized in the right lower abdomen and the last two days was no longer defecation departed. In addition, low-grade fever up to 38 C and have developed in the last few hours, a nausea. There existed no pain during urination; He did not take to be special food and a trauma has not been observed in the last ten days.
Physical examination results in a significant pressure pain in the right lower abdomen and a significant rebound tenderness in the left lower abdomen. The rectal and axillary measurement shows a temperature difference of about 1 C at 38.5 C. rectal Rectal examination also gives a distinct Tastschmerz in the right lower abdomen.

Diagnosis:

The history and the described clinical findings suggest a subacute to acute appendicitis back and the patient is admitted for immediate surgery in the hospital. In the clinic, the blood count shows leukocytosis with 18,000 leukocytes, 90% of granulocytes and 5 bar Polycyclic. The CRP is also increased considerably with 80 mg / l.

Pathogenesis:

An infection of the appendix is usually triggered by several typical enteral pathogens such as Bacteroides fragilis, enterococci and enterobacteria. Mostly go this acute infection a faecal impaction or circulatory problems ahead.

Therapy:

The patient is appendektomiert immediately, resulting in a covered perforation with localized peritonitis. After taking a smear is made on four to six days, depending on the clinical findings in addition to a short-term drainage combination therapy cefotaxime (Claforan) plus metronidazole (Clont et al) or mezlocillin (BAYPEN) plus metronidazole.

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