Appendicitis
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Appendicitis is a condition characterised by inflammation of the appendix. While mild cases may resolve without treatment, many require laparotomy with removal of the inflamed appendix. Untreated, mortality is high, mainly due to peritonitis and shock when the inflamed appendix ruptures.
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Causes
It is possible for matter to become lodged in the appendix, leading to bacterial infection, which can cause appendicitis. If the condition is untreated, the appendix can turn gangrenous and can eventually burst, leading to peritonitis, septicemia and eventually death.
Signs, symptoms and findings
The pain of appendicitis usually starts centrally (periumbilical) before localising to the right iliac fossa (the lower right side of the abdomen). There is usually associated anorexia (loss of appetite). Fever is usually present. Nausea, vomiting and diarrhea may or may not occur, but make the diagnosis more likely.
There is typically pain and tenderness in the right iliac fossa. Rebound tenderness may be present suggesting that there is some element of peritoneal irritation. If the abdomen is guarded, there should be a strong suspicion of peritonitis requiring urgent surgical intervention.
Diagnosis
Diagnosis is based on history and physical examination backed by blood tests and other diagnostic procedures.
The classical physical finding in appendicitis is diffuse pain in the umbilical region which can become localised at McBurney's point if the inflammed appendix comes into contact with the parietal peritoneum. This point is located on the right-hand side one-third of the distance between the anterior superior iliac spine and the navel, or approximately one hand's width.
Other methods include a digital rectal exam, where a finger is inserted into the rectum - if there is right sided tenderness (where the appendix normally lies), it makes it more likely that the patient has appendicitis.
Other signs used in the diagnosis of appendicitis are the psoas sign (common in retrocecal appendicitis), the obturator (internus) sign, Blomberg's sign and Rovsing's sign.
Ultrasonography and Doppler sonography also provide useful means to detect appendicitis, but in a not neglectable minority of cases (15% approximately), especially those in an early stadium without fluid build-up, an ultrasonography of the iliac fossa region do not reveal abnormalities despite of present appendicitis. Yet, sonographic imaging can often distinguish between appendicitis and another disease with very similar symptoms, namely the inflammation of the lymph nodes near the appendix. In situations where a CT scan is easily and readily available, it is the preferred test of choice. A properly performed CT scan has a detection rate (sensitivity) of over 95%. What is looked for on CT scan is the lack of contrast(oral dye) in the appendix as well as signs of appendiceal enlargement, usually >6mm on cross section; there may also be evidence of inflammation in the so called "fat stranding". Ultrasounds are especially useful to assess for gynecologic causes of right lower quadrant abdominal pain in women as the CT scan is not the imaging modality of choice in this circumstance.
Treatment
Appendicitis can be treated by removal of the appendix through a surgical procedure called an appendicectomy (also known as an appendectomy).
Antibiotics are often given intravenously to help kill remaining bacteria and thus reduce the inflammation.
Prognosis
Most appendicitis patients recover easily with treatment, but complications can occur if treatment is delayed or if peritonitis occurs secondary to a perforated appendix.
Recovery time depends on age, condition, complications, and other circumstances but usually is between 10 and 28 days.
The real possibility of life-threatening peritonitis is the reason why acute appendicitis warrants speedy treatment. The patient may have to undergo a medical evacuation. Appendicectomies have occasionally been performed in emergency conditions (i.e. outside of a proper hospital), when a timely medical evacuation was impossible.
External links
- The Merck Manual of Diagnosis and Therapy: Appendicitis (http://www.merck.com/mrkshared/mmanual/section3/chapter25/25e.jsp)da:Blindtarmsbetændelse
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