ACUTE APPENDICITIS
Incidence and epidemiology
Pathogenesis of appendicitis and appendiceal perforation
Cause
By Fecalith (m/c in adults)
Submucosal lymphoid follicular hyperplasia (m/c in children)
60? ???? carcinoid ?? ?? ??
CLINICAL MANIFESTATIONS
Abdominal pain >95%
Anorexia >70%
Constipation 4-16%
Diarrhea 4-16%
Fever 10-20%
Migration of pain to RLQ 50-60%
Nausea >65%
Vomiting 50-75%
Alvarado Score
Likelihood of appendicitis
≤ 4: Low
5–6: Moderate
≥ 7: High
Laboratory testing
RLQ tenderness, +rebound (?? ??? ?? CT? ??)
Imaging
US for children/pregnant, CT for adults
USG
?? 7mm?? ???? ?? ?????, appendicolith
??? ???? DOC
?? 3?? ? abscess? ?/??.. ??? ??? ?? ????. ??? ??? ??
CT
Density ??,
peri-appendiceal inflammation ? fat stranding
Special patient populations
??? omentum ??? ??? ??? pan-peritonitis?. ??/??? ?? perforation risk ?
Treatment
- Nonperforated
- ??? ??? ? ??? ?? ? ?? ? ???
- Perforated
- Antibiotics & bowel rest + either 1
- PCD (contained abscess)
- I&D with appendectomy ? ??? (? ??? ? ??)
- ???
- ??? + ?? ?? ? ?? ? ?? ?? ?? (CT/sono)
- ?? ?? – transrectal, vaginal, perQ if >4cm or ??
- ????, WBC nl ?? ?? ? 6-8? ? ?? ??? (???? ?? ???? ?? ??? ?? ??)
Acute peritonitis
Etiology
Clinical features
Sudden, severe pain (perforation) followed by temporary relief (decompression) and then, generalized, constant pain (peritonitis)
??? ???
????: SAAG<1.1g/dL. (??? ? ??? ?)
??? ?? ????
ADA > 40U/L