8. Acute appendicitis

Question 1

APPENDICITIS –Etiology And Pathogenesis ?

Answer 1

• Obstruction of the lumen due to fecaliths or hypertrophy of lymphoid tissue is proposed as the main etiologic factor in acute appendicitis.

Question 2

APENDICITIS - Symptomps ?

Answer 2

• Start with periumbilical and diffuse pain that eventually localizes to the right lower quadrant.
• N and V.
• Anorexia.
• Diarrhea (rarely).

Question 3

APPENDICITIS - Signs ?

Answer 3

• Eleveted temperature.
• Tachycardia.
• pts usually move slowly and prefer to lie supine due to the peritoneal irritation.
• Pain and tenderness (McBurney’s point).
• A muscular resistance (guarding) in the right iliac fossa.
• Rebound tenderness (blumberg’s sign).
• Indirect tenderness (Rovsing’s sign).

Question 4

APPENDICITIS Laboratory tests ?

Answer 4

• Mild leukocytosis. (acute, uncomplicated appendicitis)
• The proportion of neutrophils is usually very high.
• CRP elevation.
• Urinalysis.

Question 5

What score do we use for APPENDICITIS ?

Answer 5

• Alvarado score:
• <3 low likelihood of appendicitis.
• 4-6 Consider further imaging.
• > 7 high likelihood of appendicitis.

Question 6

APPENDICITIS - Imaging studies ?

Answer 6

• Abdominal ultrasonography is a popular imaging modality for acute appendicitis.
• Appendiceal ultrasound showing distended, noncompressible appendix (diameter >6-7mm).