Acute Appendicitis Presentation PDF

Acute appendicitis Dr Enemuo V.C  Introduction A tubular worm like structure arising from the posteromedial aspect of the caecum. Can be afflicted by several diseases When inflamed can give rise to acute appendicitis It is the commonest cause of acute abdomen in young a...

Acute appendicitis Dr Enemuo V.C  Introduction A tubular worm like structure arising from the posteromedial aspect of the caecum. Can be afflicted by several diseases When inflamed can give rise to acute appendicitis It is the commonest cause of acute abdomen in young adults worldwide Anatomy of the appendix Blood supply Position of the appendix Histology Embryology  Aetilogy Dietary ;refined food and sugars Socio –economic status. Obstruction; fibrous, faecolith,lymphoid hyperplasia or worms Infection ;URTI,  Pathology Simple or catarrhal ;if untreated resolves with fibrosis. Obstructive;inflamation, oedema, increased intraluminal pressure,venous statsis and arterial thrombosis,gangrene and perforation.  Pathogenesis Perforation may lead to -walled off abscess -localised peritonitis -generalised peritonitis appendix mass  Clincal presentation AVARADO’S SCORE;;clinical scoring sytem.6 clinical and 2 laboratory.total score of 10 MANTRELS 5or 6 compatible with appendicitis,7 or 8 probably appendicitis.9 or 10 most likely appendicitis.  Abdominal signs Pointing sign Cough sign Tenderness at mc burney’s point Rebound tenderness Guarding and rigidity. Rovsing’s sign Psoas sign Obturator sign  Investigations Leucocytosis High resolution ultrasonography Computer tomography  Differential Typhoid perforation Perforated peptic ulcer Acute cholecystitis Acute intestinal obstruction Acute diverticulitis Mesenteric adenitis Acute chron’s disease  Gynaecological Salpingitis Ruptured ectopic pregnancy Torsion of ovarian cyst Ruptured graffian follicle  Genito-urinary Right ureteric colic Right pyelonephritis Right epididymo--orchitis  Medical condition Gastro-enteritis Right basal pneumonia Diabetic ketoacidosis Herpes zoster Sickle cell disease malaria  Complications of acute appendicitis Generalised peritonitis Appendix mass Appendix abscess Sub-hepatic or sub-phrenic abscess Pylephlebitis septicaemia  Appendix mass Treatment is conservative viz; the Oschner-sherren’s regimen -mark the mass per adomen;checked twice daily -hourly monitoring of pulse -4hourly monitoring of temperature - fluid diet otherwise nil per oral if vomiting -iv rehydration and NG tube if there is vomiting and ileus  Intervention Continued increase or failure of reduction Persisting pain Swinging temperature Rising pulse Deterioration Persistent vomiting. Surgery for Appendectomy Surgery for Appendectomy  Complication of appendectomy Abscess formation General peritonitis Haemorrhage Pyelephlebitis Paralytic ileus Wound infection UTI ECF  OTHERS Recurrent acute appendicitis Chronic appendicitis