The partial of the peritoneum, iliac fossa, is in Appendix cancer. The appendix having been perforated ulcerations, occasioned the lodgement of the fecal concretions in its cavity, extravasation takes place, and inflame- of an and serious is originated. Nature in the too part , at instance subtle over the , and proves fatal. The appendicitis are discussed article.
- It is in males.
- It is in white races.
- Fiber prevents appendicitis. Less fiber the chance of appendicitis.
- It is in May, and August-seasonal variation- epidemic appendicitis.
- Active mucosal edema, , and that afters get contaminated appendicitis.
- The family in 30% of appendicitis in with appendicitis happening in first relatives.
- Obstruction of the lumen of appendix in obstructive appendicitis.
- Blockage —faecoliths, stricture, body, roundworm, or threadworm.
- Adhesions and kinking—carcinoma caecum , ileocaecal Crohn’s .
- Distal colonic obstruction.
- Abuse of purgatives.
- Faecolith is the most .
Coli (85%), enterococci, (30%), streptococci, Anaerobic streptococci, Cl. Welchii, Bacteroides.
Pseudoappendicitis is appendicitis acute ileitis following Yersinia . It is Crohn’s .
Symptoms of appendicitis
The appendicitis are enlisted below:
- Sudden that on the of the
- The sudden that impels your navel and shifts to your right abdomen.
- Pain that aggravates cough, or make any jarring movements.
- Nausea and vomiting
- Low-grade fever
- Loss of appetite (anorexia)
- Constipation or diarrhea
The of your alter, age and of your appendix. When you’re pregnant, the from your stomach because your appendix is to the position pregnancy.
Clinical in appendicitis
- Rovsing’s sign
- Blumberg’s sign (Release sign)
- Cope’s psoas
- Bastede sign
- Dumphy’s cough tenderness sign (Refer to fascinating for detail)
- Bapat shaking
- Heel Drop
Acute appendicitis in infancy: Even it , it has 80% of perforation with mortality (50%).
Acute appendicitis in :
- Here localization , and so peritonitis early.
- It early surgery. Dehydration, septicemia are .
In the :
Gangrene and perforation are . Because of the lax wall, localization is poor, and so peritonitis in early.
- Incidence is 1 in 2,000 pregnancies. It is in 1st and trimesters.
- Appendix shifts to the . So the is and lateral.
- Rebound tenderness and guarding be evident.
- TC very with neutrophilia.
- The of labor is 15%.
- Fetal in early appendicitis is 5% 29% appendix perforates in pregnancy.
- After six months, maternal mortality ten than and also end labor.
- Appendicitis is the most non-gynaecologic surgical emergency .
- The of perforation is in the trimester.
- Surgery is the treatment.
- Acute of the mucous membrane with the secondary obstruction causes acute nonobstructive appendicitis. It resolution, fibrosis, recurrent appendicitis, or eventual obstructive appendicitis.
- Luminal obstruction faecolith, lymphoid hyperplasia, pinworm (Oxyuris Vermicularis), worms, body, carcinoma/Crohn’s -mucus, and inflammatory fluid collects lumen– intraluminal pressure— blockage of lymphatic and venous drainage– in edema of mucosa and wall- mucosal ulceration and ischemia —bacterial translocation —bacterial the submucosa and muscular Propria –acute obstructive appendicitis—thrombosis of the appendicular artery–ischaemic necrosis of thickness of the wall of the appendix–gangrene of the appendix—perforation tip or at –peritonitis.
- After perforation– localization omentum and dilated ileum —with suppuration and pus forming an appendicular abscess.
- In acute appendicitis, —localization can omentum and dilated ileum pus —forming an appendicular mass.
- Acute appendicitis with obstruction at of the lumen— subsides—mucus collects lumen of the appendix in its enlargement—Mucocele of the appendix.
Acute nonobstructive appendicitis (catarrhal) (mucosal appendicitis):
Inflammation of mucous membrane with redness, edema, and hemorrhages which for following courses:
- Recurrent appendicitis
- Gangrene- in nonobstructive type later can
- Acute obstructive appendicitis: Here, pus collects blocked lumen of the appendix, that blackish, gangrenous, oedematous, and progresses, to perforation either tip or at of the appendix. This peritonitis, the formation of an appendicular abscess or pelvic abscess. Most , there thrombosis of the appendicular artery.
- Recurrent appendicitis: Repeated of nonobstructive appendicitis fibrosis, adhesions recurrent appendicitis.
- Subacute appendicitis is a milder of acute appendicitis.
- Stump appendicitis is retained stump of the appendix after laparoscopic appendicectomy.
- It is the age of, in and age groups.
- Pain: It is the earliest symptom. Visceral umbilicus distension of appendix, and later after hours, somatic in iliac fossa of parietal peritoneum an appendix. The eventually becomes extreme and diffuse, which the of into peritoneal cavity.
- Vomiting: Due to reflex pylorospasm.
- • Pain—first • Vomiting—next • Temperature—last
- Constipation is hallmark, diarrhea can if the appendix is in ileal or pelvic positions.
- Fever, tachycardia, foetor oris are .
- Urinary reiterations: Inflamed appendix in with bladder and can cause the bladder infection.
- Tenderness and rebound tenderness at McBurney’s is the in iliac fossa ( sign-Blumberg ‘s sign) are typical.
- Rovsing’s sign: On palpating left iliac fossa, iliac fossa, of bowel loops, which irritates the parietal peritoneum.
- Hyperextension (in case of retrocausal appendix-Cope’s psoas ) or rotation (in case of the pelvic appendix-obturator ) of the hip in iliac fossa of the psoas muscle and obturator internus muscle respectively.
- Baldwin’s is in Retrocaecal appendix- legs are lifted with the knee extended, the complains of over the flanks.
- P/R tenderness on the of the rectum
- Hyperaesthesia in ‘Sherren’s triangle.’ This triangle is assembled the anterosuperior iliac spine, umbilicus, pubic symphysis.
Differential Diagnosis for Acute Appendicitis
- Many mimic acute appendicitis. It differs in , adults, , and females.
- They have a perforated duodenal ulcer. In duodenal ulcer perforation, fluid creeps to the paracolic gutter and mimics appendicitis. Upper , obliterated liver dullness, gas the diaphragm in X-ray, and CT differentiate it from acute appendicitis.
- Acute cholecystitis: Pain , fever, jaundice, guarding are the of acute cholecystitis. US; HIDA , LFT will differentiate it from acute appendicitis.
- Acute pancreatitis: Pain in epigastrium, radiating to back, raised serum amylase and lipase, CT with a of alcohol intake are diagnostic.
- Right ureteric colic: Pain is colicky in nature, which refers to genitalia. Haematuria, urinary are . It mimics Retrocaecal/pelvic acute appendicitis. Often in ureteric stone, the is and non-tender. CT is an .
- Acute typhlitis: Inflammation of caecum is as typhlitis. Often it from acute appendicitis. Intravenous/oral metronidazole controls the .
- Acute bacterial enterocolitis: It with , diarrhea, toxemia, dehydration. Often from acute appendicitis.
- Right-sided acute pyelonephritis: Here, there and tenderness in loin. Urine analysis, US are diagnostic. Often DTPA needed.
- Crohn ‘s with acute similar of acute appendicitis.
- Pelvic inflammatory , like salpingo-oophoritis, mimics acute appendicitis.
- Twisted/hemorrhagic/ruptured ovarian cyst/ruptured ectopic gestation/endometriosis/Tubo-ovarian abscess mimics acute appendicitis. US laparoscopy helps it from others. Mittelschmerz is the rupture of the follicular cyst in mid-cycle. It subsides on its own. There systemic .
- Meckel’s diverticulitis clinically like acute appendicitis. It possible clinically.
- Intussusception mimics acute appendicitis in . ISS is the age years. Acute appendicitis is the age years. Palpable mass, of intestinal obstruction, barium enema X-ray, US are methods .
- Worm infestation (roundworm bolus/ball): It as iliac fossa.
- Properties of intestinal obstruction are common here.
- Right-sided lobar pneumonia and pleurisy are easy from acute appendicitis. Pleural rub, trade-in breath sounds, chest X-ray can pneumonia.
- Testicular torsion/acute orchitis acute appendicitis. Referred iliac fossa, and if scrotum palpated clinically these are for acute appendicitis. These are much if the testis is undescended
- Sigmoid diverticulitis in with loop towards as iliac fossa.
- Carcinoma caecum with of acute appendicitis any typical .
- Ruptured aortic aneurysm, acute intestinal obstruction, mesenteric ischemia as acute appendicitis.
- Rare like preherpetic of the and dorsal nerves acute appendicitis. Guarding and will be . There size hyperaesthesia.
- Tabetic , tuberculosis of the spine, secondaries spine, myeloma, osteoporotic can mimic acute appendicitis.
- Acute of porphyria and diabetes mellitus mimic acute appendicitis with abdominal ache.
=> Perforated peptic ulcer
=> Ruptured or twisted ovarian cyst
=> Acute cholecystitis
=> Right ureteric colic
=> Right acute pyelonephritis
=> Mesenteric lymphadenitis
=> Lobar pneumonia
=> Acute pancreatitis
=> Meckel’s diverticulitis
=> Acute of porphyria
=> Ectopic gestation—ruptured
Differential diagnosis in teenager (children)
=> Meckel’s diverticulitis
=> Acute colitis
=> Acute iliac lymphadenitis
=> Roundworm colic
=> Lobar pneumonia
Differential in females
=> Ruptured ectopic gestation
=> Mittelschmerz rupture of the ovarian follicle the mid-menstrual period
=> Ovarian cyst torsion
=> Acute diverticulitis
=> Carcinoma caecum—acute
=> Mesenteric ischemia
=> Intestinal obstruction
=> Aortic aneurysm leak
Sequelae of acute appendicitis
=> Relapse and recurrent appendicitis
=> Appendicular mass
=> Appendicular abscess
=> Perforation—has 20% mortality
=> Peritonitis, septicemia
=> Portal pyemia
=> Intestinal obstruction obstructive ileus, inflammatory adhesion, the formation of the band appendix and omentum or the appendix and small bowel
- The leucocyte is .
- Ultrasound is to rule out like ureteric stone, pancreatitis, ovarian cyst, ectopic pregnancy, and to appendicular mass or abscess.
- Laparoscopy is the most method.
Sonographic for appendicitis (85% Specificity)
- Noncompressible appendix of size > 6 mm AP diameter, hyperechoic thickened appendix wall > 2 mm— sign.
- Interruption of submucosal continuity.
- Periappendicular fluid.
- Kalam Alvarado scoring (1994), the shift to the left is removed.
- Tzamakis scoring 2005- tenderness-4; rebound tenderness-3; > 12,000/cm-2; USG -6.
- RIPASA scoring (2010)-with parameters.
- Anderson scoring – parameters.