A 31-year-old woman presented with worsening lower abdominal pain that started in the right lower quadrant and migrated. On examination, she had direct and rebound tenderness in the right lower quadrant. CT scan showed signs of acute appendicitis. She was diagnosed with acute appendicitis and underwent a laparoscopic appendectomy under general anesthesia.

2. the case of a woman
Group 1
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3. Chief Complaint

4. Chief Complaint
“I’m a 31-year-old woman”

5. Chief Complaint
“I’m a 31-year-old woman”
“I have pain in lower part of the belly.”

6. Chief Complaint
“I’m a 31-year-old woman”
“I have pain in lower part of the belly.”
It started this morning at 5am.

7. Present Illness

8. Present Illness
Lower abdominal pain

9. Present Illness
Migrating pain

10. Present Illness
Flank pain

11. Present Illness
The worst pain
Right lower quadrant

12. Present Illness
The worst pain
Right lower quadrant

13. Present Illness
Last meal and drink
yesterday around 8 pm

14. Present Illness
Last meal and drink
yesterday around 8 pm

15. Present Illness
Last defecation
yesterday evening

16. History
Alcohol
3 times a week
1bottle of soju

17. History
Smoking
7 pack year

18. History
Smoking
7 pack year

19. History
Family history
DM-, HTN-, Tb-, Hepatitis-
Allergy
none
Genital history
unmarried
Last menstrual period 3weeks ago
Last intercourse 1week ago

20. Review of System
[General] [GI]
General weakness - Abdominal pain +
Fever - Anorexia +
Chill - Nausea +
Poor oral intake - Vomiting +
[HEENT] Diarrhea -
Headache - [GU]
Dizziness - Flank pain +
[Respiratory] Hematuria -
Cough - Dysuria -
Sputum - Incomplete voiding -
Vaginal discharge +

21. Physical Examination
[Vital sign]
BP: 120/60mmHg, HR: 60 /min, RR: 16 /min, Temp:
36.6℃
[General appearance]
Acutely so ill-looking appearance
[Consciousness level]
Alert
[Chest]
Regular heart beat without murmur
Clear breath sound without rale
[Abdomen]
Abdomen palpation: Soft & Flat
Direct tenderness: + Rebound tenderness: + on RLQ
Bowel sound: normoactive
Rovsing sign: + Psoas sign : - Obturator sign : -

22. Result of Work-up
Abdomen-pelvic CT

23. Result of Work-up
Abdomen-pelvic CT

24. Final Diagnosis
Acute Appendicitis

25. Treatment
Laparoscopic Appendectomy
Under the general anesthesia, a small
arcuate infra-umbilical incision is made