k25 acute appendicitis

8/10/2019 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

k25 acute appendicitis

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