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Name:

Hospital of Affiliation:

Date:

Day and time of duty:

 _____________________________

Student’s sign 

OUR LADY OF FATIMA UNIVERSITY

Regalado, Fairview Quezon City

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 AppendicitisAppendicitis is a condition characterized inflammation of the appendix. It is classified as a medical emergency and

many cases require removal of the inflamed appendix, either by laparotomy or  laparoscopy. 

Signs and symptoms

Location of the appendix in thedigestive system 

Pain first, vomiting next and fever last has been described as the classic presentation of acute appendicitis. Since theinnervation of the appendix enters thespinal cord at the level T10, the same level as the umbilicus (belly button), the pain

begins mid-abdomen. Later, as the appendix becomes more inflamed and irritates the adjoining abdominal wall, it tends to

localize over several hours into the right lower quadrant, except in children under three years. This pain can be elicited

through various signs and can be severe. Signs include localized findings in the right iliac fossa. The abdominal wall

becomes very sensitive to gentle pressure (palpation). Also, there is severe pain on sudden release of deep pressure in the

lower abdomen (rebound tenderness).

Causes

On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the

appendix lumen (the inside space of a tubular structure).[7][8]

 Once this obstruction occurs, the appendix subsequently

becomes filled with mucus and swells, increasing pressures within the lumen and the walls of the appendix, resultingin thrombosis and occlusion of the small vessels, and stasis of  lymphatic flow. Rarely, spontaneous recovery can occur at

this point. As the former progresses, the appendix becomes ischemic and then necrotic. As bacteria begin to leak out

through the dying walls, pus forms within and around the appendix (suppuration). The end result of this cascade is

appendiceal rupture (a 'burst appendix') causing peritonitis, which may lead to septicemia and eventually death. 

The causative agents include foreign bodies, trauma, intestinal worms, lymphadenitis, and, most commonly, calcified fecal

deposits known as appendicoliths or fecaliths

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Diagnosis

Diagnosis is based on patient history (symptoms) and physical examination backed by an elevation of neutrophilic white

blood cells. Histories fall into two categories, typical and atypical. Typical appendicitis usually includes abdominal pain

beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. The pain then

"settles" into the right lower quadrant (or the left lower quadrant in patients with situs inversus totalis), where tenderness

develops.

Blood and urine test

Most patients suspected of having appendicitis would be asked to do a blood test. Half of the time, the blood test is normal,

so it is not foolproof in diagnosing appendicitis.

Two forms of blood tests are commonly done: Full blood count (FBC), also known as complete blood count (CBC), is an

inexpensive and commonly requested blood test. It involves measuring the blood for its richness in red blood cells, as well

as the number of the various white blood cell constituents in it. The number of white cells in the blood is usually less than

10,000 cells per cubic millimeter 

X –Ray

In 10% of patients with appendicitis, plain abdominal x-ray may demonstrate hard formed feces in the lumen of the appendix(Fecolith). It is agreed that the finding of Fecolith in the appendix on X  – ray alone is a reason to operate to remove the

appendix, because of the potential to cause worsening symptoms.

Management

 Acute appendicitis is typically managed by surgery however in uncomplicated cases antibiotics are both effective and safe.

Antibiotics

While antibiotics are effective for treating uncomplicated appendicitis 20% of people had a recurrence within a year and

required eventual appendectomy.[29] 

Surgery

Inflamed appendix removal by open surgery

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Laparoscopic appendectomy.

The surgical procedure for the removal of the appendix is called an appendicectomy  (also known as an appendectomy ).

Often now the operation can be performed via a laparoscopic approach, or via three small incisions with a camera to

visualize the area of interest in the abdomen. If the findings reveal suppurative appendicitis with complications such as

rupture, abscess, adhesions, etc., conversion to open laparotomy may be necessary. An openlaparotomy incision if requiredmost often centers on the area of maximum tenderness, McBurney's point, in the right lower quadrant. A transverse or a

gridiron diagonal incision is used most commonly.