Surgery Definition – What is appendicitis?
Surgery Definition – What is appendicitis?
Appendicitis is an acute inflammation of the appendix. Appendicitis is associated with obstruction of the lumen. The causes of appendicitis are faecolith , worms or seed obstruction of the lumen, or lymphoid hyperplasia, Crohn’s disease, vascular disease of appendiceal artery on the mural of the appendix and cecal tumor and peritonitis on the extraluminal of the appendix.
Appendicitis may present with symptoms and signs such as fever, anorexia, vomiting, nausea and periumbilical pain to right iliac fossa pain. The periumbilical pain to right iliac fossa pain occurs due to the location of the appendix. Appendix is a midgut structure. The pain from appendicitis occurs first in the periumbilical region known as visceral pain/ referred pain. Continuous inflammation may lead to ischemia, die of the mural nerve ending and referred pain will end. This is followed by localized right iliac fossa pain due to irritation of the peritoneum overlying the inflamed appendix known as somatic pain.
Appendicitis is diagnosed clinically based on the history and examination. The clinical finding of appendicitis may present with flushed appearance, lying still and febrile in appearance. The patient may have tachycardia and the hand appear clammy. There will be a distinctive odor to the breath or fetor oris. Coated tongue is also common. Abdominal examination may reveal rebound tenderness and guarding especially at the McBurney’s pint.
Appendicitis is associated with special signs such as obturator sign, Rovsing’s sign and psoas signs.
The investigation requires for appendicitis may include urine dipstick to exclude urinary tract infection due to the present of leucocytes and calculi. Urine pregnancy test is also considered to exclude the present of ectopic pregnancy. Full blood count in appendicitis’ patient may reveal mild leukocytosis and neutrophilia. Ultrasound scan may also be considered.
Appendicitis is managed by admitting the patient to the ward. Administer Iv fluid, iv analgesia usually opiates, iv antibiotics in the form of third generation cephalosporin, nill by mouth (no food intake by mouth) and appendicectomy. In the case of non perforated appendicitis, antibiotic is given one dose intra operative and two doses post operative. If appendicitis is perforated antibiotics should be continued for five to seven days’ post operative.
There are two ways to perform appendicectomy which include open appendicectomy or closed appendicectomy. In open appendicectomy, the layers that need to go through include skin, subcutaneous fat, Camper’s fascia, Scarpa’s fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia and peritoneum.
The base of the appendix can be identifed by following the taeniae coli of the cecum down to the base of the appendix where convergence occurs. The appendix may be normal in appendicectomy and in this case, other causes of right iliac fossa need to be considered and the normal appendix need to be removed to avoid confusion in the future.
There are certain conditions where appendicecotmy is not performed such as when the surgery is not feasible, the present of appendix mass with no signs of peritonitis and patient is in poor surgical condition.
The complication of appendicectomy may include perforation, abscess, peritonitis which occur pre operatively, hematoma, infection, fecal fistula, residual abscess and inguinal hernia due to division of the ilioinguinal nerve, thromboembolism and retention of the urine early post operatively and adhesions post operatively.
The conservative treatment may include a course of antibiotics with an interval appendicectomy performed 6-8 weeks later.
Appendicitis is an acute inflammation of the appendix. Appendicitis is associated with obstruction of the lumen. The causes of appendicitis are faecolith , worms or seed obstruction of the lumen, or lymphoid hyperplasia, Crohn’s disease, vascular disease of appendiceal artery on the mural of the appendix and cecal tumor and peritonitis on the extraluminal of the appendix.
Appendicitis may present with symptoms and signs such as fever, anorexia, vomiting, nausea and periumbilical pain to right iliac fossa pain. The periumbilical pain to right iliac fossa pain occurs due to the location of the appendix. Appendix is a midgut structure. The pain from appendicitis occurs first in the periumbilical region known as visceral pain/ referred pain. Continuous inflammation may lead to ischemia, die of the mural nerve ending and referred pain will end. This is followed by localized right iliac fossa pain due to irritation of the peritoneum overlying the inflamed appendix known as somatic pain.
Appendicitis is diagnosed clinically based on the history and examination. The clinical finding of appendicitis may present with flushed appearance, lying still and febrile in appearance. The patient may have tachycardia and the hand appear clammy. There will be a distinctive odor to the breath or fetor oris. Coated tongue is also common. Abdominal examination may reveal rebound tenderness and guarding especially at the McBurney’s pint.
Appendicitis is associated with special signs such as obturator sign, Rovsing’s sign and psoas signs.
The investigation requires for appendicitis may include urine dipstick to exclude urinary tract infection due to the present of leucocytes and calculi. Urine pregnancy test is also considered to exclude the present of ectopic pregnancy. Full blood count in appendicitis’ patient may reveal mild leukocytosis and neutrophilia. Ultrasound scan may also be considered.
Appendicitis is managed by admitting the patient to the ward. Administer Iv fluid, iv analgesia usually opiates, iv antibiotics in the form of third generation cephalosporin, nill by mouth (no food intake by mouth) and appendicectomy. In the case of non perforated appendicitis, antibiotic is given one dose intra operative and two doses post operative. If appendicitis is perforated antibiotics should be continued for five to seven days’ post operative.
There are two ways to perform appendicectomy which include open appendicectomy or closed appendicectomy. In open appendicectomy, the layers that need to go through include skin, subcutaneous fat, Camper’s fascia, Scarpa’s fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia and peritoneum.
The base of the appendix can be identifed by following the taeniae coli of the cecum down to the base of the appendix where convergence occurs. The appendix may be normal in appendicectomy and in this case, other causes of right iliac fossa need to be considered and the normal appendix need to be removed to avoid confusion in the future.
There are certain conditions where appendicecotmy is not performed such as when the surgery is not feasible, the present of appendix mass with no signs of peritonitis and patient is in poor surgical condition.
The complication of appendicectomy may include perforation, abscess, peritonitis which occur pre operatively, hematoma, infection, fecal fistula, residual abscess and inguinal hernia due to division of the ilioinguinal nerve, thromboembolism and retention of the urine early post operatively and adhesions post operatively.
The conservative treatment may include a course of antibiotics with an interval appendicectomy performed 6-8 weeks later.