Appendicitis As

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APPENDICITISIntroduction Appendicitis is the most common cause of abdominal sepsis Appendicectomy is the most common emergency surgical

operation



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



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



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



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



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



DIFFERENTIAL DIAGNOSIS

Urinary tract infection

Mesenteric adenitis

Constipation Gynaecological disorders

Perforation of another abdominal viscus

Acute pancreatitis Non spesific abdominal upset



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.



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.

Appendicitis As

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