Post on 04-Jun-2018
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APPENDICITISIntroduction Appendicitis is the most common cause of abdominal sepsis Appendicectomy is the most common emergency surgical
operation
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Anatomy
The appendix is a blind-ending tube arising from thecaecum at the meeting point of the three taenia coli
The appendix is a 5-8 cm diverticulum arising from thececum at the convergence of the teniae coli
The appendiceal wall has mucosal, submucosal,muscular, and serosal layers
Is innervated by T-10, the same somatic innervation asthe skin surrounding the umbilicus
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Physiology
The function of the appendix in the adulthuman is unknown but is likely to berelated to the role of the lymphoid tissue
in immunologic processes
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Cardinal features of acuteappendicitis
Abdominal pain for less than 72 hours
Vomiting 1-3 times
Facial flush
Tenderness concentrated in the right iliac fossa
Rebound tenderness in the right iliac fossa
Anterior tenderness on rectal examination
Fever between 37,3 and 38,5 C
No evidence of UTI on urine microscopy
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DIAGNOSIS ANDINVESTIGATION
Diagnosis of acute appendicitis is madelargely on clinical grounds
When the diagnosis is not immediately
evident, the patient should have repeatedabdominal examination, preferably by thesame examiner, every 2 to 3 hours
Laboratory tests and radiologicexamination are also useful, particularlywhen the diagnosis is uncertain
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LABORATORY TESTS
Mild leukocytosis with some shift to theleft is the most common finding. Absenceof any leukocytosis suggest but by no
means proves the absence of acuteappendicitis
In retrocecal appendicitis, the urine may
contain red cell and leukocytes
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DIFFERENTIAL DIAGNOSIS
Urinary tract infection
Mesenteric adenitis
Constipation Gynaecological disorders
Perforation of another abdominal viscus
Acute pancreatitis Non spesific abdominal upset
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Urinary Tract Infection : (Cystitis orPyelonefphritis )
Mesenteric Adenitis :Inflamation andenlargement of abdominal lymph nodes oftenassociated with an URI. Symptoms and signsmay be similar to those early appendicitis but
without rectal tenderness. Fever is typicallyhigher than in appendicitis (greater than 38.5deg C) and settles rapidly.
Constipation : May cause colickly abdominalpain and iliac fossa tenderness. There is nofever and the rectum is loaded with faeces.
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Perforation of another abdominal viscus: Aperforated Meckel’s diverticulum may
present exactly like appendicitis. Acute pancreatitis: pain is predominantly
central. If there is tenderness in right iliac
fossa, it will also be present in theepigastrium. If in doubt, the serumamylase should be measured.
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