DIAGNOSIS APENDISITIS

Dr Donald Aronggear SpB SMF Bedah RSUD Jayapura Papua 2007

Epidemiologi
7% penduduk US 1,1 per 1000 penduduk per tahun Laki-laki : perempuan = 1,4 : 1 Mortality rate 0,2-0,8% Mortality rate pada usia > 70 th = 20% Perforasi paling tinggi umur < 18 th dan >50 th USA 250.000 apendektomi/tahun

Anatomi

ACUTE APPENDICSITIS
Predisposing factor Causative factor Obstructive agents : - low fibers diet : - obstruction - infection : - in the lumen of the appendix: - fecalith - corpus aleinum - parasite : - intra lumenar origin - haematogenous origin

Infective agents

Pathology
Obstruction of the lumen Mucous retention Distension (increase intraluminar pressure) Lymph and venous occlusion Mucosal and sub mucosal oedema Bacterial translokation Inflammation / suppuration Pus enter the lumen Over distension Arteriak occlusion Pressure necrosis / gangrene perforation

Progression of disease
- Gangrenous

- Perforation : - general peritonitis - peri appendicular mass: - phlegmoon / infiltrate - absces - sepsis

Symtoms
- abdominal pain: - visceral - somatic - anorectia, nausea, vomiting - obstipation - Others: - dysuria - leucorrhoea

Signs
- Tenderness on the rigth iliac fossa (specifically on Mc Bourney point) - Rebound tenderness - Muscular guarding (locally) - Rectal examination : pain in the right - sometimes : - right rectal rigidity - hypersensitive on the sherens triangle

Signs

Rovsings sign Psoass sign Obsturators sign Tern Horn sign

Psoas sign

Obturator sign

TANDA & GEJALA

TANDA & GEJALA

Laboratory finding
- Leucocytosis

(more than 10. 000/cm2

- Diff. Tell : shift to the left (neutrofilia) - Urinalisa - PP Test - CRP

Differential Diagnosis
1. G.I Tract.

- mesenteric lymphadenitis - peptic ulcer perforation - acute cholecystitis - diverticulitis : - jejunal - ileal (Meckel) - colonic - ileitis terminalis - tumor of the cecum

2. Urinary tract. - rigth ureteric colic - urinary tract infection 3. Gynaecologic disease. - ruptured ectopic pregnancy - twisted / torsion ovarian cyste - ruptured ovarian cyste - adnexitis 4. Non specific abdominal pain

Treatment
Acute appendicsitis : appendectomy Negative pathology : 15 20 % perappendicular mass : - conservative treatment : - bed rest (fowler position) - liquid diet - antibiotic if resolution : appendectomy a froid if deteriorate : laparatomy & appendectomy Radical treatment : laparatomy & appendectomy General peritonitis : laparatomy & appendectomy

Antibiotic : for gram positive , gram negative

and anaerobe microganisme

Regimen

: - ampicilin, gentamycin and metronidazol - seftriaxon and metronidazol

CHRONIC APPENDICITIS
- Chronic abdominal pain in the rigth iliac fossa, but not severe - Continue or intermittent - sometimes gastritis like symptoms - The lumen of the appendix not totally obstructed - Appendicogram : - non filling - partial filling - filling defect

Ultrasonogram showing longitudinal section (arrows) of inflamed appendix.

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