INTRODUCTION

One of the international languages commonly used by almost countries around the world is English.
As a language recognized as an international language and followed by the Globalization era that
moved in fast pace, learning and master English become a must right now. The globalization era
also make many influences in medical and health field. Because of that we can learn many things
not only from our country but also from around the world. For that the ability to master, understand
and can talk English fluenty become one of skill that should be mastered in this era.

In Medical field, we are introduced by medical English. The medical English can be used for many
purposed, such as taking illness history of patient, do some informed consent, breaking the bad
news, publishing journal articles, doing national or international oral presentation or poster
presentation, any many more. Beside that, this book is also used to develop English proficiency of
the general surgery department members.

This book will consist of diseases written in medical English that the author hope, it can help in
learning program in the Udayana department of surgery
 INTRODUCTION

Appendicitis comes from Latin, which means the inflammation of the vermiform appendix.1
Appendicitis caused by blockage of appendix and lead to the secretion of fluids by the appendix. 2
Appendix has been described as narrow and long, passing upward behind the cecum, to the left
behind the ileum and mesentery, or downward and inward into the pelvis. 3,4 Appendix usually
located in right lower quadran of abdomen. But, it also can be located in almost any area of the
abdomen, depending on any abnormal developmental issue. 1

Appendicitis mostly occurs between the ages of 5 until 45, with the mean age of 28. The incidence
is approximately 233/per 100,000 people. Males have a slightly higher risk to develop acute
appendicitis than females, with a lifetime incidence is 8.6% for men and 6.7% for women.
Approximately 300,000 cases of hospital visits yearly in the United States is related to
appendicitis.5

There were Geographical differences for the risk of acute appendicitis. The risk of acute
appendicitis is 9% in the USA, 8% in Europe, and 2% in Africa. There are great variation in the
presentation, severity of the disease, radiological workup, and surgical management of patients
having acute appendicitis that are related to country income. The rate of perforation varies from
16% to 40%, with a highest frequency occurring in population older than 50 years (55–70%),
followed by younger age population (40–57%). This perforation is associated with increased
morbidity and mortality compared with non perforated one.6

Because of the increased morbidity and mortality, we need to know how to diagnose and treat the
appendicitis especially the perforated appendicitis correctly. The authors hope this book can help in
learning program. Beside that, this book is also used to develop English proficiency of the general
surgery department members.

1. Vaos G, Dimopoulou A, Gkioka E, Zavras N. Immediate surgery or conservative treatment

for complicated acute appendicitis in children? A meta-analysis. J Pediatr Surg. 2019
Jul;54(7):1365-1371. [PubMed]
2. Wangensteen OH, Dennis C: Experimental proof of the obstructive origin of appendicitis in
man. Ann Surg. 1939, 110:629-647. 10.1097/00000658-193910000-00011
3. Gray H: Anatomy, Descriptive and Surgical, 1901 Edition. Pick TP, Howden R (ed):
Running Press, Philadelphia, PA; 1901.
4. Krzyzak M, Mulrooney S M (June 11, 2020) Acute Appendicitis Review: Background,
Epidemiology, Diagnosis, and Treatment. Cureus 12(6): e8562. doi:10.7759/cureus.8562
5. Jones MW, Lopez RA, Deppen JG. Appendicitis. [Updated 2022 May 1]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
6. Di Saverio, S., Podda, M., De Simone, B. et al. Diagnosis and treatment of acute
appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 15, 27
(2020). https://doi.org/10.1186/s13017-020-00306-3
 Appendicitis

Chief Complaint : Patient usually complains with pain in periumbilical area that can migrate into
the right lower quadrant of abdomen

History of present illness : Doctor should ask about any symptoms like pain in periumbilical area
or midabdominal discomfort followed by nausea, anorexia, and indigestion (constipation or
diarrhea). The pain is continuos but not severe, with occasional mild cramping. Importantly,
withing several hours of onset of symptoms the pain shift to the right lower quadrant and localized.

Risk Factor
Past Medical History : Doctor should ask about the history of abdominal pain before.
Family History : Doctor should ask about history of {disease} in patient family before
Drug History : Doctor should ask if the patient is already given any treatment before.
Life style : Doctor should ask if the patient have any change of life style or habit before.

Diagnosis .
Physical Examination : Doctor should find any signs such as :
- Fever (≥ 37.5oC)
- Tachycardia
- Rebound tenderness
- Defans musculare
- Specific sign :
o Rovsing sign : Pain in the mc burney area when the doctor palpate the left
lower quadrant of abdomen
o Psoas sign : pain in the right lower quadrant of abdomen when the doctor
do extension of right hip.
o Obturator sign : Pain in the right lower quadrant of abdomen when the
doctor do the flexion and internal rotation of right hip
o Blumberg sign : pain in the mc burney area
- Alvarado score :
 Source: Alvarado A. Clinical Approach in the Diagnosis of Acute Appendicitis. 2017

Interpretation :
≤ 3 : low probability
4-6 : moderate probability, need to do some additional examination or imaging studies
≥ 7 : high probability

Additional examination:
o Laboratory Findings :
 The patient should undergo laboratory examination such as Complete blood count to
find any leucocytosis (≥ 10.000/µL), Urinalysis usually normal, pregnancy test
o Imaging studies :
 Abdominal X ray : to find fecalith
 Ultrasonography : to assest the condition of appendix (diameter, inflammation,
edema)
 CT Scan abdomen : to find any sign of dilatation of appendix lumen and the
thickened wall of appendix, or periappendicial fat stranding

Treatment :
- Surgical : Appendectomy (open or laparoscopy)
- Non surgical :
o Nil per os
o Fluid resuscitation
o Antibiotics
o Anti vomitus drugs
o Pain-Killer * If needed
Pre op care :
-Informed consent
-Doctor need to make sure the patient condition is optimum to do the surgery
-Stop eating 6-8 hours before surgery
-Given preoperative antibiotics 2 hours before surgery

Post op care :
- Antibiotics
- Fluid maintenance
- Vital sign observation
- Symptoms observation : pain, vomit, mobilitation (sitting, walking), flatus or defecation.
- Wound care and visit the doctor 3 days after discharge.

Bibliography
1. Brunicardi FC, et al. Schwart’s Principle of Surgery. 10 th ed. New York. Mc Graw Hill;
2014
2. Doherty GM. Current diagnosis and treatment of surgery 14th ed. Lange. Mc Graw Hill;
2015