appendicitis

acute appendicitis is when patient suddenly develop symptoms and signs of appendicitis due to inflammation of the APPENDIX

appendix is a small organ posteromedial to the ileoceacal junction at the convergence of the 3 tanea coli in length about 8-10cm. it either located at retrocecal (70%), postileal, subcecal or pelvis. they found that appendix plays a function to secrete igA. it is supplied by appendicular artery that lies on the mesothelium and drained out by the venous system through superior mesenteric vein.

usually appendicitis occurred most in young white men or those people with retrocecal appendix (poor blood supply). And usually it occurred due to worm ball ( yersinia colitis, escherichia coli, ect)

compared to non obstructive appendicitis where the inflammation occurred slowly, obstructive appendicitis is more dangerous where it can lead to perforation. this is due to single lumen of the appendix, thin omentum and end artery that lead to fast ischemia and gangrene.

patient probably would complain of symptoms like umbilical pain (visceral nerve) and later probably radiate to right iliac fossa region (parietal innervation). nausea & vomiting (pylorospasm), low grade fever (inflammatory mediators), hyperasthesia (irritation to lower lumbar nerves). upon examination some signs can be elicited like positive cough test (parietal irritation), positive Blumberg's sign (rebound tenderness due to parietal irritation), positive cope's psoas and obturator test (irritation to both psoas & obturator muscle)

usually patient will be graded by alvarado score M,A,N,T,R,E,L,L (10 marks)

if the patient came within 48H without any suspicion of appendicular mass or abscess emergency appendicectomy will be done (usually through laparotomy). but if appendicular mass is suspected patient will be started on Ochsner & Shenner regime (Aspiration through Ryle's tube, Bowel care without purgatives agents, temperature, pulse, BP Charts, Drugs (2nd gen ceph and flagyl), maintenance Fluid. 6th week after the regime completed elective appendicectomy will be performed. but if abscess is suspected (high fever with more pain) drainage and antibiotic treatment before the elective appendicectomy 6 week later.type of drainage depends on the location of the appendix

appendicitis may be complicated with perforation, appendicular mass or abscess