Download - K25 Acute Appendicitis
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GIS-K-25
ACUTE APPENDICITISAppendiceal Mass / Abscess
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INTRODUCTION
The appendix is :
-Wormlike extension of the cecum (vermiform appendix).
-Length is 8-10 cm (ranging from 2-20 cm).
-Fifth month of gestation
-Several lymphoid follicles.
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Problem:
Appendicitis can mimic several abdominal conditions.
Laboratory testImaging investigation
Statistics report1 of 5 cases is misdiagnosed
Normal appendix is found in15-40% Emergency appendectomy.(Negative Appendectomy)
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Differential diagnosis of acute appendicitis
Surgical
Acute Intestinalobstruction
Intussusception
Acute cholecystitis
Perforatedpeptic ulcer
Mesenteric adenitis
Acute Meckel's diverticulitis
Acute Pancreatitis
Medical
Gastroenteritis
Basal Pneumonia dextra
Terminalileitis
Urological
Rightureteric colic
Right pyelonephritis
Urinary tract infection
Right Acute epididymitis
Gynaecological
Ectopicpregnancy
Ruptured ovarian follicle
Torted ovarian cyst
Salpingitis/pelvicinflammatory disease
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Differential diagnosis of appendicitis appendicitiscan mimic several abdominal conditions.
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Lab Studies:
Complete blood cell countA mild elevation of WBCs (ie, >10,000/L)
Urinalysis
Mild pyuria relationship of the appendix with the right
ureter.
Severe pyuria in UTI.
For women of childbearing age,Ectopic pregnancytest urin (beta-hCG)
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Special maneuvers
McBurney sign
McBurney's point
it is only the area
of greatest tenderness
Blumberg sign
Rovsings Sign
Dunphy sign Cough Test
Obturator sign
Psoas sign
Markle sign
http://en.wikipedia.org/wiki/Cough_Testhttp://en.wikipedia.org/wiki/Image:McBurney%27s_point.jpghttp://en.wikipedia.org/wiki/Cough_Test -
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Location appendix during pregnancy
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INDICATIONS
Consider an appendectomy for patients with ahistory of :
Persistent abdominal painFeverClinical signs of localized or diffuse peritonitisEspecially if leukocytosis is present.
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Imaging Studies
Abdomen plain film:Fecalith within the appendixUrolithiasis right middle third
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MANTRELS SCORE
Characteristic Score
M = Migration of pain to the RLQ 1
A = Anorexia 1
N = Nausea and vomiting 1
T = Tenderness in RLQ 2
R = Rebound pain 1
E = Elevated temperature 1
L = Leukocytosis 2
S = Shift of WBC to the left 1
Total 10
A score of 7 or more is strongly predictive of acute appendicitis.
Alvarado score 1986
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CT scan
-Oral contrast medium-Rectal Gastrografin enema
Reserved for patients-Uncertain diagnosis-Severe obesity.
more than 6 mm
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If the clinical picture is unclear
Short period (4-6 h) of watchful waiting
USG / CT scan-May improve diagnostic accuracy
Without a definite diagnosis- return for continued or recurrent symptoms- follow-up examination in 24 hours.
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Complications
Perforation
General Secondary Peritonitis
Appendiceal Mass
Appendiceal Abscess
Pylephlebitis is suppurative thrombophlebitis of the
portal venous system
Hepatic absces
Chills
High fever
Jaundice
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Two approaches to appendectomy
1. Open Emergency Appendicectomy ( Appendectomy)
2. Laparoscopic appendectomy
If normal appendix removed need to look for:
- Meckel's diverticulum
- Acute salpingitis
- Crohn's disease
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If the body successfully walls off the localized perforation
Appendiceal Mass
RLQ massThe pain may actually improve.Symptoms do not completely resolve.Still have right lower quadrant painDecreased appetiteChange in bowel habits (eg, diarrhea, constipation)Intermittent low-grade fever.
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Acute Appendicitis Appendicitis Perforation