A P P E N D I C I T I S

O T J E H U D A J A

F.K.U.K.M

2 0 0 7

A N A T O M Y

• APPENDIX VERMICULARIS• CAECUM• ILEUM TERMINALE• PLICA ILEOCAECALIS• MESOAPPENDIX / MESENTERIOLUM• A.APPENDICULARIS• M.RECTUS ABDOMINIS• M.ABD.OBLIQUS EXT / INT

ANATOMY

• SCHERREN’S TRIANGLE

• McBURNEY’S POINT

• LANZ’S POINT

C A U S E S

• OBSTRUCTION IN THE LUMEN OF APPENDIX EITHER

- BY FAECOLITH

- OR BY THE ENLARGEMENT OF

LYMPHOID FOLLICLES IN ITS WALL

RARER CAUSES

• CARCINOMA OF THE CAECUM

• CARCINOID TUMOUR

• OBSTRUCTION FIBROUS BAND

• CRUMPLED APPENDIX

• FOREIGN BODY

• MUCOCELE

IT MOST OFTEN AFFECTS

• CHILDREN

• TEENAGERS

• YOUNG ADULTS

• NOTE :

IN THE INFANT THE LUMEN OF THE APPENDIX IS WIDE.

THE DIET IS SOFT

PATHOLOGY

APPENDICITIS SIMPLEX- APPENDICITIS CATARRHALIS- APPENDICITIS SEROPURULENTA

APPENDICITIS DESTRUCTIVA- APPENDICITIS PHLEGMONOSA- APPENDICITIS EMPYEMATOSA- APPENDICITIS GANGRENOSA

SYMPTOMS

• CENTRAL/ EPIGASTRIC ABDOMINAL CRAMPING OR COLICKY PAIN LASTS APPROXIMATELY 8 HOURS.

• FOLLOWED BY A SHARP, STABING SOMATIC PAIN IN THE RIF ( RLQ )

• NAUSEA ( VOMITING IS UNCOMMON )

• LOOSE STOOL ( FRANK DIARRHOEA IS UNCOMMON )

SYMPTOMS

• LOW-GRADE PYREXIA (37.2 – 37.8°C)

• WHITE FURRED TOUNGE

• CHARACTERISTIC FETOR ( SWEET FAECAL SMELL TO BREATH )

• TACHYCARDIA ( < 100 IN FIRST 24 HOURS )

C A V E

• IN INFANT DIARRHOEA AND VOMITING MAY BE THE ONLY SYMPTOMS

• IN ELDERLY PATIENTS THERE MAY BE CONFUSSION AND LATER SHOCK MAY DEVELOP, LESS PAIN

• APPENDICITIS IN PREGNANCY- PAIN AND TENDERNESS ARE HIGHER- RISK OF ABORTION IN THE FIRST TRIMESTER, BY PERFORATION HIGHER

S I G N S

• TENDER WITH GUARDING IN RIF OVER McBURNEY’S POINT

• PER RECTUM : TENDER ANTERIORLY IN THE RECTOVESICAL OR RECTOUTERINE POUCH

• SITKOWSKI’S SIGN• BLUMBERG”S SIGN• PSOAS’S SIGN• ROVSING’S SIGN

OTHER SIGNS

• BALDWIN’S SIGN

• COPE’S SIGN

• CHAPMAN’S SIGN

• TEN-HORN’S SIGN

INVESTIGATIONS

• WHITE CELL COUNT, NEUTROPHIL LEUKOCYTOSIS

• THROMBOCYT ( DD : DENGUE )

• ULTRASOUND SCAN

• COMPUTERIZED TOMOGRAPHY

• LAPAROSCOPIC

• COLON IN LOOP

DIFFERENTIAL DIAGNOSIS

• ABDOMINAL DISEASE :

MESENTERIC ADENITIS

MECKEL’S DIVERTICULITIS

CROHN’S DISEASE

MESENTERIC EMBOLUS

RIGHT-SIDED COLONIC DIVERTICULITIS

GASTROENTERITIS

PANCREATITIS

DIFFERENTIAL DIAGNOSIS

URINARY TRACT :- RENAL COLIC- ACUTE PYELONEPHRITIS- CYSTITISGYNAECOLOGICAL CAUSES :- SALPINGITIS- ECTOPIC PREGNANCY- MITTELSCHMERZ- OVARIAL’S CYSTDENGUE

COMPLICATIONS

• APPENDIX MASS (APPENDICULAR INFILTRAT)

• APPENDIX ABSCESS (APPENDICULAR ABCES)

• PERFORATION, GENERALIZIED PERITONITIS• PELVIC ABSCESS• PARALYTIC ILEUS• SEPTICAEMIA• PORTAL PYAEMIA

COMPLICATIONS

• APPENDICITIS MAY RESOLVE SPONTANEOUSLY

• THE APPENDIX MAY BECOME SOURROUNDED BY ADJACENT SMALL BOWEL AND OMENTUM AND GIVE RISE TO AN APPENDIX MASS (WALLING OFF).THIS USUALLY HAPPENS 2-5 DAYS AFTER ONSET OF INITIAL SYMPTOMS

• IT MAY PERFORATED GIVING RISE TO GENERALIZED PERITONITIS

COMPLICATIONS

• IT MAY PERFORATE ADMIST LOCAL ADHESIONS GIVING RISE TO AN APPENDIX MASS

• OFTEN IT IS DIFFICULT TO DIAGNOSE APPENDICITIS

“ 48 HOUR RULE “

IF THE SYMPTOMS HAVE BEEN PRESENT FOR 48 HOURS AND THE DIAGNOSIS TRULY APPENDICITIS, THEN THE PATIENT SHOULD EITHER HAVE DEVELOPED AN APPENDIX MASS OR GENERALIZED PERITONITISIF NEITHER OF THESE TWO ARE PRESENT, THEN THE DIAGNOSIS OF APPENDICITIS SHOULD BE REVIEWED

TREATMENT

ACUTE APPENDICITIS : APPENDICECTOMYAPPENDIX MASS :

- CONSERVATIVELY, INTERVAL APPENDICECTOMY AFTER 3 MONTHS- EARLY SURGERY

APPENDIX ABSCESS- SURGICAL DRAINAGE AND APPEN- DICECTOMY (LAPAROTOMY)- PERCUTANEOUS INSERTION OF A DRAIN, INTERVAL APPENDICECTOMY

OPERATION

• SKIN’S INCISIONS:

TRANVERSE, OBLIQUE

• McBURNEY’S INCISION

• PARARECTAL’S INCISION

• PURSE SUTURE STRING (TABAKBEUTELNAHT/JAHITAN TABAKSACK)

• Z-SUTURE (Z-NAHT, JAHITAN Z)

ANTIBIOTIC

• PERIOPERATIVE PROPHYLACTIC

• THERAPY

• CEPHALOSPORINE

• METRONIDAZOLE