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Appendicitis
Appendicitis
Contents
Anatomy
Review
Screenshot from Essential Anatomy 5
Anatomical Position
Causes
Obstruction
Increases Luminal
and Intramural
Pressure
Intramural vessel
thrombosis
Appendiceal wall
ischemia &
necrosis
• Necrotic appendiceal wall is at risk of perforation
Appendicitis
• Perforation may lead to:
– Phlegmon
Complications
– Abscess
– Diffuse peritonitis
Bacteroides Pseudomonas
fragilis
Pepto-
streptococcus
E. coli
Signs and
symptoms
• Nausea
• Vomiting
• Anorexia
• Periumbilical abdominal pain
which later localizes to his or her
right lower quadrant
– Migratory pain only occurs in 50
Screenshot from Dr. Google to 60 percent of patients
Physical Exam
Findings
• Early on:
– General appearance
– Low grade fever (<101℉)
– Early abdominal exam may be inconclusive
Mosby's Medical Dictionary, 8th edition • Possible periumbilical pain
• As conditions progresses:
– General appearance
– High grade fever (>101℉)
– Classically, RLQ abd TTP aka tenderness at McBurney’s point
• Only occurs after inflammation spreads to involve peritoneum
– Rovsing’s sign indicates peritoneal irritation
– Psoas sign seen with retrocecal appendicitis
– Obturator sign seen with pelvic appendicitis
– Perforated appendix
– Cecal diverticulitis
– Meckel’s diverticulitis
– Pancreatitis
– Hepatitis
– Acute ileitis
– Crohn’s disease
– Gynecological and obstetrical conditions
• Tubo-ovarian abscess
• PID
• Ruptured ovarian cyst
Studies
●Perforated − 17,900±2100 cells/microL
BMP
LFTs
Beta HCG
UA
Imaging Studies
• CT
– First identify cecum or ileocecal valve (usually has fatty
lips)
– Most appendixes come out of the cecum between 2 and
6 o’clock
• Ultrasound
• MRI
Complications
• Martin R. Acute appendicitis in adults: Clinical manifestations and differential diagnosis.
Retrieved October 3, 2018, from
https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-an
d-differential-diagnosis?search=appendicitis&source=search_result&selectedTitle=3~150&us
age_type=default&display_rank=3#H5345961
.
• Jaffe BM, Berger DH. The appendix. In: Schwartz's Principles of Surgery, 8th ed, Schwartz SI,
Brunicardi CF (Eds), McGraw-Hill Companies, New York 2005.
• Bennion RS, Baron EJ, Thompson JE Jr, et al. The bacteriology of gangrenous and perforated
appendicitis--revisited. Ann Surg 1990; 211:165.
• Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000; 215:337.
• Blackbourne LH. Surgical Recall,6th Ed, Lippincott Williams & Wilkins, Baltimore 2012.
• Guraya SY, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the
severity of acute appendicitis. Saudi Med J 2005; 26:1945.
• Choi D, Park H, Lee YR, et al. The most useful findings for diagnosing acute appendicitis on
contrast-enhanced helical CT. Acta Radiol 2003; 44:574.
• Salminen P, Tuominen R, Paajanen H, et al. Five-Year Follow-up of Antibiotic Therapy for
Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. JAMA 2018;
320:1259.
References
• Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open
appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses
of randomised controlled trials. BMC Gastroenterol 2015; 15:48.
• Markar SR, Penna M, Harris A. Laparoscopic approach to appendectomy reduces the
incidence of short- and long-term post-operative bowel obstruction: systematic review and
pooled analysis. J Gastrointest Surg 2014; 18:1683.
• Awkwardyeti.com
• Radiopaedia.org