Acute appendicitis
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Acute appendicitis is the emergency surgical conditions characterized by acute right lower abdominal, vomiting, anorexia and fever due to sudden inflammation of the appendix (small tube extends from the large intestine) usually caused by obstruction of the appendix lumen. Appendectomy (removal of appendix) for acute appendicitis is most common causes of emergency abdominal surgery. Early diagnosis and emergency appendectomy is required to prevent life-threatening complications.
What causes the acute appendicitis?
Acute appendicitis is caused due to obstruction of the appendix lumen. Obstruction is due to stool, lymphoid hyperplasia, vegetable matter, parasites or a neoplasm. Obstruction of the lumen help to bacterial overgrowth leads to inflammation of appendix.
What are the signs of symptoms of acute appendicitis?
- Abdominal pain: first dull pain starts around the navel which is dull in nature than pain moves to lower right abdominal where pain become sharp in nature.
- Anorexia
- Nausea and vomiting after abdominal pain
- Fever
- Haematuria (blood in urine)
- Constipation or diarrhea
- Right iliac fossa (mc-burner point) tenderness, rebound tenderness
- Rovsing sign positive (Palpation of left iliac region of abdomen producing pain on the right iliac fossa)
What is the differential diagnosis of acute appendicitis?
- Enterocolitis
- Meckel’s diverticulitis
- Urinary tract infection
- Acute pancreatitis
- Perforated peptic ulcer
- Acute cholecystitis
- Ruptured ectopic pregnancy
- Salpingo-oophoritis
- Mittelschmerz
- Torsion of ovarian cyst
- Pneumonia
- Porphyria
- Kidney stone
- Torsion of undescended testis
How is acute appendicitis diagnosed?
Diagnosis relies on clinical finding, laboratory test, radiological examination and scoring system.
- Complete blood count: CBC shows increase white blood cell count
- Routine urine test: exclude urinary tract infection
- X-ray abdomen to rule out bowel perforation
- Abdominal ultrasound helps to diagnosed appendicitis
- CT scan of abdomen is the investigation of choice.
To avoid negative diagnosis, scoring systems have been developed considering symptoms, signs and investigations .Most used scoring system is called Alvarado scoring system. Which include:
- Migratory right iliac fossa pain (score 1)
- Anorexia (score 1)
- Nausea and vomiting (score 1)
- Tenderness right iliac fossa (score 2)
- Rebound tenderness (score 1)
- Elevated temperature (score 1)
- Leucocytosis (score 2)
- Shift to left of neutrophils (score 1)
From the above score it’s concluding as:
- Score less than 5: Diagnosis not sure
- Score 5-6: Compatible
- Score 7-8: probable
- Score more then 9: confirm
What are the complications of acute appendicitis?
- Rupture of appendix
- Appendicular mass
- Appendicular abscess
- Faecal fistula
- Peritonitis
How is acute appendicitis managed?
- Should be admitted to hospital
- Fluid and electrolyte maintenance
- Regular vital checkup
- Intravenous antibiotic
- Emergency appendectomy is the only management and should be done with out any delay. Some time patients present in hospital with the appendicular mass in this case operation should be postponed for 6-8 weeks.
What is the prognosis of acute appendicitis?
With early diagnosis and treatment prognosis is excellent.
References:
- patient.co.uk
- medicinenet.com
- emedicine.medscape.com
- nlm.nih.gov
- bettermedicine.com
- webmd.com
- Sabiston textbook of surgery 18th edi.
Filed Under: GI
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