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        <div id="content-top1">Page 73 - CSIF Sanidad CientÃ­fica -Junio 2018- | CSIF Sanidad AndalucÃ­a</div>
        <div id="content-top2">P. 73</div>
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    <pre style="white-space:pre-line"><code>CSIF SANIDAD CIENTÃFICA
     N. 13 â€“ Junio 2018

Antecedentes epidemiolÃ³gicos: vive en                  Imagen 1- RadiografÃ­a de tÃ³rax y abdomen
ambiente urbano
                                                       Imagen 2 - RadiografÃ­a de tÃ³rax: Ã­ndice cardio-
    - El 27 de agosto del 2013:                        torÃ¡cico en lÃ­mite, resto normal
Acude a urgencias por fiebre de 39-40 ÂºC,
diaria, sin predominio a lo largo del dÃ­a que          Imagen 3 - RadiografÃ­a de abdomen: sin
cede con antipirÃ©ticos, acompaÃ±ada de                  hallazgos de interÃ©s
cefalea, mialgias, tiritona e intensa
sudoraciÃ³n. No otros sÃ­ntomas por Ã³rganos y            ValoraciÃ³n de cirugÃ­a general
aparatos.
                                                       ExploraciÃ³n fÃ­sica: abdomen blando,
         El paciente consultÃ³ en otro hospital
donde se pautÃ³ tratamiento con paracetamol             ligeramente distendido, doloroso a la

         e ibuprofeno. Se le extrajo una               palpaciÃ³n superficial y profunda en
serologÃ­a cuyos resultados estÃ¡n
                                                       hemiabdomen derecho, con defensa
         pendientes.
                                                       voluntaria a dicho nivel, Blumberg positivo y
    - 4 de septiembre:
Ha continuado con fiebre, diaria, a la que se          Rovsing positivo  en FID con peritonismo
ha aÃ±adido en las Ãºltimas 24 horas dolor
abdominal, continuo, localizado en FID, con            y defensa abdominal. RHA conservados. PPR
distensiÃ³n y nÃ¡useas sin vÃ³mitos. No
alteraciÃ³n del trÃ¡nsito intestinal. No ictericia,
acolia ni coluria.
Acude a nuestra urgencia aportando analÃ­tica
donde destaca, GOT: 289, GPT: 318, GGT:
673, FA: 231, PCR: 25 y TAC abdomen
donde se observa liquido libre, localizado en
hemiabdomen derecho desde subhepÃ¡tico a
FID y gotiera paracÃ³lica, se identifica una
estructura tubular compatible con apÃ©ndice
engrosado y signos indirectos de apendicitis
aguda (cambios inflamatorios de la grasa
ileocecal y periapendicular).
Se interconsulta con cirugÃ­a general.

Exploraciones complementarias
HematimetrÃ­a: Leucocitos: 5880 (47.4%N,
42.7%L), Hemoglobina 14.9, plaquetas:
121.000,
BioquÃ­mica: GOT: 149, GPT: 203, GGT:
411, Fosfatasa Alcalina: 151, LDH 774, BT:
1, resto normal, PCR: 21.5.
CoagulaciÃ³n: TP: 112.7 % INR: 1, TTPA:
42.4 segundos (25-38), fibrinÃ³geno: 308.

                                                       bilateral: negativa. Resto de exploraciÃ³n sin

                                                       hallazgos.

                                                   73</code></pre>
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