Untitled Quiz

Study Notes

Acute appendicitis is an inflammation of the appendix, a small, finger-shaped pouch that extends from the colon.
It is the most common cause of acute abdominal pain in young adults worldwide.

The appendix is a tubular, worm-like structure arising from the posteromedial aspect of the caecum.

Dietary factors, such as refined food and sugars, may contribute to the development of appendicitis.
Socio-economic status can also play a role.
Obstruction is a major cause, which can be caused by fibrous material, faecolith, lymphoid hyperplasia, or worms.
Infection, such as upper respiratory tract infection, can also trigger appendicitis.

Appendicitis can be classified as simple or catarrhal, which can resolve with fibrosis if left untreated.
Obstructive appendicitis is characterized by inflammation, oedema, increased intraluminal pressure, venous stasis, arterial thrombosis, gangrene, and perforation.
Perforation can lead to walled-off abscess, localized peritonitis, generalized peritonitis, or an appendix mass.

Alvarado's score is a clinical scoring system used to assess the likelihood of appendicitis. It includes 6 clinical and 2 laboratory parameters.
A score of 5-6 is compatible with appendicitis, 7-8 suggests probable appendicitis, and 9-10 indicates a high probability.
Clinical signs include:
- Pointing sign
- Cough sign
- Tenderness at McBurney’s point
- Rebound tenderness
- Guarding and rigidity.
- Rovsing’s sign
- Psoas sign
- Obturator sign

Leukocytosis (increased white blood cell count) is a common finding.
High-resolution ultrasonography is a valuable tool for diagnosing appendicitis.
Computer tomography can provide further confirmation and help identify complications.

It is important to differentiate appendicitis from other conditions that can cause similar symptoms.
This includes:
- Typhoid perforation
- Perforated peptic ulcer
- Acute cholecystitis
- Acute intestinal obstruction
- Acute diverticulitis
- Mesenteric adenitis
- Acute Crohn’s disease

Appendicitis can sometimes mimic gynecological conditions:
- Salpingitis (inflammation of fallopian tubes)
- Ruptured ectopic pregnancy
- Torsion of ovarian cyst
- Ruptured graffian follicle

Appendicitis symptoms can also be similar to genito-urinary conditions:
- Right ureteric colic
- Right pyelonephritis (inflammation of the kidney)
- Right epididymo-orchitis (inflammation of the epididymis and testicle)

An appendix mass is a collection of pus and inflammatory tissue that develops when the appendix becomes inflamed and blocked.
Treatment for an appendix mass is usually conservative, following the Oschner-Sherren's regimen:
- Mark the mass on the abdomen and check it twice daily.
- Monitor the patient's pulse hourly and temperature four-hourly.
- Provide fluids and a fluid diet if vomiting or ileus.
- Rehydration and nasogastric tube placement are used for vomiting and ileus.

Surgery is necessary if there is continued increase or failure of reduction in symptoms, persistent pain, swinging temperature, rising pulse, deterioration, or persistent vomiting.
An appendectomy is performed to remove the inflamed appendix.

Recurrent acute appendicitis refers to repeated episodes of appendicitis.
Chronic appendicitis is a rare condition characterized by persistent, but less severe, symptoms compared to acute appendicitis.