Acute Appendicitis An Overview

Appendicitis is a common cause of right lower abdominal pain associated with poor appetite. There may be associated vomiting, diarrhoea, and fever. But what is appendicitis? What are the treatment options? Appendicitis treatment without surgery - is it possible?

Appendicitis, also called epityphilitis, is the infection or inflammation (severe irritation) of the appendix - the tiniest part of the bowel, a worm-like out pouching of the bowel at the junction of the small and large intestine as shown in the picture of the appendix to your right.

The Appendix is an Contents organ at the Overvie beginning of the w large intestine History (caecum). It Causes measures about 7 to 15 cm long and Pathoph 0.5 to 1.5cm wide. ysiology It is a rare in other Signs & animals to find an Sympto appendix - only a ms few species have it. Lab Its definite function Test is not known. It was thought to be a vestigial organ in human. Current evidence however suggests that the appendix is indeed a very important organ that helps in the immune functions of the bowel. It is believed to house "good bacteria" and releases same to the bowel to aid the normal balance and function of gut.

Differen tials Complic ations Treatm ent

Recover y preventi on In Pregnan cy Appendi citis in Children

The appendix, located in the lower right side of the abdomen, is a redundant worm like organ, whose function in man is not known. Like other parts of the bowel, it has a lumen. On the wall of the lumen, we have some lymph glands like the glands in the neck which become swollen when we have cold or flu. The cells on the wall of the appendix also secret mucus to keep the appendix lubricated

DIAGNOSIS OF APPENDICITIS

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Contents

The diagnosis of appendicitis is mainly based on the story (history) given by the patient and the findings on examining the patient. Laboratory of radiological test for appendicitis are usually used to confirm the suspicion of appendicitis, or disprove it. Though there are laboratory and radiology investigations that can be ordered, there is no one test that can for sure confirm appendicitis on every occasion. The common test done for appendicitis includes blood test, urine test and sometimes plain abdominal x-ray, ultrasound, and CT scan.

Overvie w History Causes Pathoph ysiology Signs & Sympto ms Lab Test Differen tials Complic ations Treatm ent Recover y preventi on In Pregnan cy

Blood Test

In Most patients suspected of Children having appendicitis would be asked to do a blood test. 50% of the times, the blood test may be normal. So it is not fool proof in diagnosing appendicitis.

Two form of blood tests commonly done:

FBC (Full blood count) or CBC (Complete blood count), depending on which side of the Atlantic you live in) is an inexpensive and commonly requested blood test. It involves the blood measured 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 a usually less than 10,000cells per cubic millimetre. An abnormal rise in the number of white blood cells in the blood is a crude indicator of infection or inflammation going on in the body. Such rise is not specific to appendicitis alone. If it is abnormally elevated, with a good history and examination findings pointing towards appendicitis, the likelihood of having the disease is higher. In pregnancy, there may be a normal elevation of white blood cells, without any infection present.

CRP is an acronym for Cryo-Reactive Proteins. It is an acute phase response protein produced by the liver in response to any infection or inflammatory process in the body. Again, like the FBC, it is not a specific test. It is another crude marker of infection or inflammation. Inflammation at ANY site can lead to the CRP to rise. A significant rise in CRP with corresponding signs and symptoms of appendicitis is a useful indicator in the diagnosis of appendicitis. It is said that if CRP continues to be normal after 72 hours of the onset of pain, it is likely that the appendicitis will resolve on its own without intervention. A worsening CRP with good history is a sure signal fire of impending perforation or rupture and abscess formation.

Urine Test
Urine test in appendicitis is usually normal. It may however show blood if the appendix is rubbing on the bladder, causing irritation. A urine test or urinalysis is compulsory in women, to rule out pregnancy in appendicitis, as well to help ensure that the abdominal pain felt and thought to be acute appendicitis is not in fact, due to ectopic pregnancy.

X Ray

In 10% of patients with appendicitis, plain abdominal x-ray may demonstrate hard formed faeces in the lumen of the appendix (Faecolith). It is agreed that the finding of Faecolith in the appendix on X ray alone is a reason to operate to remove the appendix, because of the potential to cause worsening symptoms. In this respect, a plain abdominal X-ray may be useful in the diagnosis of appendicitis, though plain abdominal x- ray is no longer requested routinely in suspected cases of appendicitis. An abdominal X ray may be done with a barium enema contrast to diagnose appendicitis. Barium enema is whitish toothpaste like material that is passed up into the rectum to act as a contrast. It will usually fill the whole of the large bowel. In normal appendix, the lumen will be present and the barium fills it up and is seen when the x-ray film is shot. In appendicitis, the lumen of the appendix will not be visible on the barium film.

Ultrasound Scan

The normal appendix is not frequently visible on ultrasound scan. If seen, it is most likely that the appendix is inflamed. Ultra sound scan may demonstrate free fluid around a swollen appendix. An outer thickness of greater than 7mm on scan is also highly suggestive of inflammation of the appendix. Graded Compression Ultrasound greatly improves the sensitivity of ultrasound scan in the diagnosis of appendicitis in all age groups and sex. Graded Compression Ultrasound has been demonstrated to have a sensitivity of 100% and specificity of 96 % and accuracy of 98% in the diagnosis of appendicitis during pregnancy (Lim et al, 1992).

CT Scan

CT scan or computed tomography scan is a specialised form of x-ray. The patient is passed through a big doughnut-like machine and x-rays 400

times the normal is used to look at the body in slices of about 5millimeter thickness. It is used in a very wide selection of medical cases. It is not advised to be used in pregnancy, except where the benefit strongly out weighs the risk. A dye may be given to help improve the visibility of tissues, by acting as a contrast. Helical CT scan has greatly improved the diagnosis of appendicitis. It is rapidly becoming the only diagnostic tool with some certainty. The future will tell if it will be able to diagnose appendicitis with 100% accuracy.

Scoring Systems in Appendicitis

In the diagnosis of appendicitis, some physicians have come up with a scoring system, which compiles all the clinical signs and symptoms a patient have, gives it a mathematical number, and if the score reaches a particular total or threshold, a diagnosis of appendicitis is said to be very likely. Scoring systems are not frequently used, but the following are the available scoring systems in appendicitis diagnosis.

MANTRELS or Alvarado Scoring. The Alvarado scoring system in appendicitis, also called the MANTRELS scoring, makes use of clinical signs, symptoms and laboratory findings. Each of the alphabets represents a sign or symptom, and a score of 1 is award to each, where they exist, except T and S that are scored 2 each. The components are as follows: M = Movement of pain to the right iliac fossa A= Anorexia N = Nausea and Vomiting T = Tenderness in the right iliac fossa R = Rebound tenderness E= Elevated temperature and L = Leucocytosis greater than 10,000/mm2 S = Shift in white blood cell count to the right. A total score of 10 is the maximum that can be accumulated.

A score of 8 10 is said to be highly predictive of appendicitis and is a call for immediate appendicectomy or operation for the removal of the appendix. A score of 7 8 is indicative of appendicitis. 5 6 means there is the possibility of appendicitis, and 1 4 makes the diagnosis of appendicitis unlikely. Any one scoring 5 8 needs regular clinical re-evaluation and reassessment with a view to confirming the diagnosis and operate. A score of greater than 6 in children makes the possibility of appendicitis up to 100% likely.

The Paediatric Appendicitis Scoring abbreviated PAS Scoring in children is another predictive scoring system used in the diagnosis of appendicitis. This scoring system is designed for use in children between the ages of 4 15 years. It is more or less a modified Alvarado or MANTRELS scoring. It uses 8 variables (laboratory findings as well as sighs and symptoms), to which a score is of 1 or 2 is given to each variable, where they exist. The maximum score that can be accumulated is 10. The presence of Anorexia, Pyrexia, Nausea or Vomiting, Leucoystosis greater than 10,000, migration of pain, and high neutrophils are given a score of 1 each. Tenderness on coughing, hopping or percussing the abdomen is given a score of 2. So too is the presence of tenderness in the right lower abdominal region. A Paediatric Appendicitis Score of 6 and above is highly indicative of appendicitis in children.

Tzanakis Scoring. Tzanakis and colleagues, in 2005 published a simplified system, now called the Tzanakis scoring system for appendicitis, to aid the diagnosis of appendicitis. It incorporates the presence 4 variables made up of specific signs and symptoms (presence of right lower abdominal tenderness = 4points and rebound tenderness = 3), laboratory findings (presence of white blood cells greater than 12,000 in the blood = 2) as well as ultrasound findings (presence of positive ultrasound scan findings of appendicitis = 6), to which scores are allocated, in the computing of a scoring to predict the presence of appendicitis.

A total score of 15 is the maximum that can be scored. Where a patient scores 8 or more points, there is greater than 96 percent chance that appendicitis exists.

Fine Catheter Peritoneal Cytology

This is a rather old fashioned test for appendicitis, and it is hardly used today for the diagnosis of appendicitis. Abbreviated FCPC, fine catheter peritoneal cytology when used, has a high predictive value for diagnosing appendicitis. It involves the introduction of a fine catheter into the abdominal cavity below the level of the umbilicus or navel, and then the catheter is directed to the right iliac fossa and peritoneal fluid aspirated, and stained in the lab with Giemsa stain. If over half of the cells in the aspirate are white blood cells (neutrophils), the test is said to be positive, and appendicitis is most likely. The draw back of this test is in women where a positive test can also occur with a pelvic inflammatory disease. To differentiate appendicitis from a host of other causes of abdominal pain, please see the section on differential diagnosis of appendicitis.

Reference:
Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002 Jun; 37:87781. Tzanakis NE, Efstathiou SP, Danulidis K, et al: A new approach to accurate diagnosis of acute appendicitis. World J Surg 2005 Sep; 29(9): 1151-6, discussion

Treatment of Appendicitis The Options, What To Expect and Complications

The treatment of appendicitis requires speed as well as making the right judgment call. Should antibiotics only be employed? Should you go for key hole surgery or open surgery? What should I expect? When can I go back to work? What about complications if any?

If nothing is done to treat an inflamed appendix within three days of unset of symptoms, the natural progression of the disease is that the condition worsens, pus may collect around the appendix forming an appendix abscess, an appendix mass may form, it may rupture, with potentially fatal sequelae. How to treat appendicitis? Because appendicitis is a potentially life threatening condition, it is best treated in the hospital by qualified doctors with experience in this field. The definitive treatment of appendicitis is by surgically removing the diseased appendix in an operation known as appendicectomy or appendectomy. It must be quickly mentioned here that where surgical option does not exist, like those on a submarine mission, or in a remote outpost, it is life saving to treat appendicitis with antibiotics. Doing so though, only buys time. The appendicitis may re-occur again. It must be stressed that is not the best option. A broad spectrum antibiotic is usually advised. This may include a choice of metronidazole, at a dose of 500mg three times daily with cefuroxime or augumentin 1.2grams 8hrly given through the veins. The gold standard for the treatment of appendicitis is by an operation to take off the offending appendix.

This involves putting the patient to sleep under general anaesthetics to prevent pain during the operation. The operation can be done either as a key hole surgery (laparoscopic) or the traditional open knife surgery.

Treatment of Appendicitis: Keyhole or Open Surgery?

The decision whether to do a key hole appendectomy or open appendectomy depends on a number of factors, including the surgeon's experience with this procedure (keyhole surgery), the fitness of the patient for endoscopic appendicectomy and the level of complication expected or even occurring during a previously planned endoscopic (laparoscopic) surgery. Most surgeons will not perform a laparoscopic appendicectomy (appendectomy) if: The patient is severely obese Patient is too frail for prolonged anaesthesia There is fear of the appendix already ruptured and may need extensive internal abdominal toileting The expertise and or facility for endoscopic appendicectomy does not exist. Please discuss with your surgeon and agree on a choice of how to treat appendicitis in you or your loved one where possible.Some have asked: what's the difference between a key hole removal of the appendix and an open one? Well, in terms of getting the job done, both methods achieve exactly the same result - the appendix is removed, curing the appendicitis. The main difference lies in:
1. The open surgery tends to be a faster procedure(usually about 20 to 30 minutes operating time), meaning less time under general anaesthetics, and on the operating table, especially important if patient has some other illness, frail or difficulty with breathing or chest problems. The key hole surgery or laparoscopic removal of the appendix tend to take longer (about 60 to 90 minutes), though operating time is getting shorter these days, with more and more surgeons operating this way

2. Key hole appendicitis operation leaves smaller (0.5 to 1.5cm scar but up to four) scars on the abdomen , as against the traditional open surgery that leaves a 5 to 10 cm scar on the right lower abdomen 3. More importantly, there tends to be less pain and quicker recovery after a key hole surgery

Please be warned: If complications occurs during a keyhole appendicectomy, the surgeon may have to convert the surgery to an open operation to save life. Many of such complications are often unpredictable as well as out of the operating surgeons control. They could include unexpected rupture of the appendix, uncontrollable blood loss (bleeding), or the finding of a large necrotic tumour with or without a diseased appendix. More reasons to leave how to treat appendicitis - the details of it to your surgeon!

Preparation Before The Surgery

Surgery for the treatment of appendicitis is usually done as an emergency operation. Even at that, adequate preparation will help reduce complication rates after surgery, and aid smooth recovery. The following preparation is expected in most cases: The procedure to be undertaken is explained to the patient Should have nothing to eat or drink for at least 4 to 6 hours before the operating time - to prevent patient vomiting stomach content into the lungs when put to sleep under general anaesthesia. This could have fatal consequences An intravenous line will be inserted to take some bloods for testing, if not already done, to see your blood count level, if you have enough "salts" (electrolytes) in your blood, and how well your blood clotting system is. You are most likely going to get some intravenous fluids given to help restore lost fluids to our body and optimize your circulation. In the treatment of appendicitis, it is also important that you get good pain killers preferably intravenously, as well as some antibiotics given top you intravenously before the operation. You will then be transferred to theater for the operation. Remember, you will not feel pain during the operation, and it is usually a very straight forward procedure with very very high success rate.

The Procedure
After putting the patient to sleep, he or she is transferred unto the operating table. The abdomen is thoroughly cleaned with special antiseptic solutions, special coverings placed over the abdomen. Dignity is ensured at every moment, seeing that patient is properly covered even while asleep, and only the region to be operated on is exposed. If it is a key hole surgery,

1. A cut is made around the belly button (umbilicus), and a small tube introduced into the abdomen to put in some carbon-dioxide gas to help expand the space in the abdomen to provide room for the operation inside 2. 2 to 3 other cuts are made to introduce the instruments that will be used to remove the appendix, including the telescope (camera) for viewing the field been operated upon. 3. The appendix is identified and tied with a ligature, cut off and delivered through a cut on the wall of the abdomen - usually the 1 to 1.5cm cut by the belly button (umbilicus). 4. The wound on the abdominal wall is sutured and closed. 5. Plaster applied to the closed wound, and the operation is finished. For an open procedure, step 1 and 2 is skipped, and instead, a direct cut is made on the abdomen, the appendix see under direct vision, tied off and removed.

After Surgery for Treatment of Appendicitis

Patient is then transferred over to the recovery room, where he or she gradually "recovers" from the anaesthesia, wakes up only to find out that the operation is long finished. You may have nurses or doctors checking your blood pressure, see that you have adequate pain control, and that you are not bleeding from the operation site. After a an hour or so, patient is transferred to a proper post operative ward, observed for a day or two. You should be able to start sips of clear fluids from the end of the first day, light food by day two, and Discharged home at the end of day 2 or day 3. You may need some additional antibiotics (often not required!) to go home, depending on if the surgery is deemed "clean" or not in terms of any faecal contamination during the operation. Simple pain killers like paracetamol or codeine with ibuprofen may be given to control pain You will need to keep the site of the wound clean and free from water for about 7 days, when the stitches will need to be removed, if a type of stitch that is not absorbed is used to close the skin.

Other Frequently Asked Questions After Appendicectomy

Common questions asked after treatment of appendicitis include: 1. When can I start to have my bath after surgery? Answer: As soon as you feel okay to do so, without causing excessive pain and strain to the operated site, and more importantly, not letting water to touch the healing wound within the first 7 to 10 days. Once the stitches have been removed and the wound looks dry and healed, you can start having your bath fully. 2. When can I resume sex after surgery? Answer: Again, when you feel comfortable to, but ideally, not before the first 2 weeks after surgery, so as not to put too much strain on your abdominal wound. 3. When can I go back to work after an appendicectomy operation? Answer: After an open surgery, you need about 4 weeks to recover on the average, especially if your work involves lifting, or prolonged standing, or shouting. This is more so after an open appendicectomy operation. For a key hole surgery, 2 weeks is often enough rest time. 4. When can I start driving after an a surgical operation to remove the appendix? Answer: Drive when you feel comfortable to. Be sure you are able to do the emergency stop manoeuvrings without any pain. Always cross check with your car insurance provider.

Treatment of Appendicitis : The Complications of Surgery

Generally, this operation is straight forward, and the vast majority of people do not have any significant complication after surgery. But it is worth noting that every surgery carries some risk as well as complications. Following the treatment of appendicitis by surgery, expect to Obviously have a scar, You may bleed, and there is a Risk of the wound getting infected. If a nerve that runs in the area of the operation called the ilioinguinal nerve is inadvertently damaged, the patient could come up with hernia in the future. The risk of general anaesthesia is also there. For those who will have key-hole surgery, the gas pumped into the abdominal cavity may cause irritation of your diaphragm and

possibly pain at the tip of the shoulder for some days after the surgery

There is also a tiny risk of some individuals developing chronic abdominal pain after many months or years following the operation from what is called adhesions caused after surgery - especially open surgery

appendicitis (redirected from Ruptured appendix)

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Definition
Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased. Appendicitis is a medical emergency, and if it is left untreated the appendix may rupture and cause a potentially fatal infection.

Description
Appendicitis is the most common abdominal emergency found in children and young adults. One person in 15 develops appendicitis in his or her lifetime. The incidence is highest among males aged 10-14, and among females aged 15-19. More males than females develop appendicitis between puberty and age 25. It is rare in the elderly and in children under the age of two. The hallmark symptom of appendicitis is increasingly severe abdominal pain. Since many different conditions can cause abdominal pain, an accurate diagnosis of appendicitis can be difficult. A timely diagnosis is important, however, because a delay can result in perforation, or rupture, of the appendix. When this happens, the infected contents of the appendix spill into the abdomen, potentially causing a serious infection of the abdomen called peritonitis. Other conditions can have similar symptoms, especially in women. These include pelvic inflammatory disease, ruptured ovarian follicles, ruptured ovarian cysts, tubal pregnancies, and endometriosis. Various forms of stomach upset and bowel inflammation may also mimic appendicitis. The treatment for acute (sudden, severe) appendicitis is an appendectomy, surgery to remove the appendix. Because

of the potential for a life-threatening ruptured appendix, persons suspected of having appendicitis are often taken to surgery before the diagnosis is certain.

Causes and symptoms

The causes of appendicitis are not well understood, but it is believed to occur as a result of one or more of these factors: an obstruction within the appendix, the development of an ulceration (an abnormal change in tissue accompanied by the death of cells) within the appendix, and the invasion of bacteria. Under these conditions, bacteria may multiply within the appendix. The appendix may become swollen and filled with pus (a fluid formed in infected tissue, consisting of while blood cells and cellular debris), and may eventually rupture. Signs of rupture include the presence of symptoms for more than 24 hours, a fever, a high white blood cell count, and a fast heart rate. Very rarely, the inflammation and symptoms of appendicitis may disappear but recur again later. The distinguishing symptom of appendicitis is pain beginning around or above the navel. The pain, which may be severe or only achy and uncomfortable, eventually moves into the right lower corner of the abdomen. There, it becomes more steady and more severe, and often increases with movement, coughing, and so forth. The abdomen often becomes rigid and tender to the touch. Increasing rigidity and tenderness indicates an increased likelihood of perforation and peritonitis. Loss of appetite is very common. Nausea and vomiting may occur in about half of the cases and occasionally there may be constipation or diarrhea. The temperature may be normal or slightly elevated. The presence of a fever may indicate that the appendix has ruptured.

Diagnosis
A careful examination is the best way to diagnose appendicitis. It is often difficult even for experienced physicians to distinguish the symptoms of appendicitis from those of other abdominal disorders. Therefore, very specific questioning and a thorough physical examination are crucial. The physician should ask questions, such as where the pain is centered, whether the pain has shifted, and where the pain began. The physician should press on the abdomen to judge the location of the pain and the degree of tenderness. The typical sequence of symptoms is present in about 50% of cases. In the other half of cases, less typical patterns may be seen, especially in pregnant women, older patients, and infants. In pregnant women, appendicitis is easily masked by the frequent occurrence of mild abdominal pain and nausea from other causes. Elderly patients may feel less pain and tenderness than most patients, thereby delaying diagnosis and treatment, and leading to rupture in 30% of cases. Infants and young children often have diarrhea, vomiting, and fever in addition to pain. While laboratory tests cannot establish the diagnosis, an increased white cell count may point to appendicitis. Urinalysis may help to rule out a urinary tract infection that can mimic appendicitis.

Key terms
Appendectomy (or appendicectomy) Surgical removal of the appendix. Appendix The worm-shaped pouch attached to the cecum, the beginning of the large intestine. Laparotomy Surgical incision into the loin, between the ribs and the pelvis, which offers surgeons a view inside the abdominal cavity. Peritonitis Inflammation of the peritoneum, membranes lining the abdominal pelvic wall. Patients whose symptoms and physical examination are compatible with a diagnosis of appendicitis are usually

taken immediately to surgery, where a laparotomy (surgical exploration of the abdomen) is done to confirm the diagnosis. In cases with a questionable diagnosis, other tests, such as a computed tomography scan (CT) may be performed to avoid unnecessary surgery. An ultrasound examination of the abdomen may help to identify an inflamed appendix or other condition that would explain the symptoms. Abdominal x-rays are not of much value except when the appendix has ruptured. Often, the diagnosis is not certain until an operation is done. To avoid a ruptured appendix, surgery may be recommended without delay if the symptoms point clearly to appendicitis. If the symptoms are not clear, surgery may be postponed until they progress enough to confirm a diagnosis. When appendicitis is strongly suspected in a woman of child-bearing age, a diagnostic laparoscopy (an examination of the interior of the abdomen) is sometimes recommended before the appendectomy in order to be sure that a gynecological problem, such as a ruptured ovarian cyst, is not causing the pain. In this procedure, a lighted viewing tube is inserted into the abdomen through a small incision around the navel. A normal appendix is discovered in about 10-20% of patients who undergo laparotomy, because of suspected appendicitis. Sometimes the surgeon will remove a normal appendix as a safeguard against appendicitis in the future. During the surgery, another specific cause for the pain and symptoms of appendicitis is found for about 30% of these patients.

Treatment
The treatment of appendicitis is an immediate appendectomy. This may be done by opening the abdomen in the standard open appendectomy technique, or through laparoscopy. In laparoscopy, a smaller incision is made through the navel. Both methods can successfully accomplish the removal of the appendix. It is not certain that laparoscopy holds any advantage over open appendectomy. When the appendix has ruptured, patients undergoing a laparoscopic appendectomy may have to be switched to the open appendectomy procedure for the successful management of the rupture. If a ruptured appendix is left untreated, the condition is fatal.

Prognosis
Appendicitis is usually treated successfully by appendectomy. Unless there are complications, the patient should recover without further problems. The mortality rate in cases without complications is less than 0.1%. When an appendix has ruptured, or a severe infection has developed, the likelihood is higher for complications, with slower recovery, or death from disease. There are higher rates of perforation and mortality among children and the elderly.

Prevention
Appendicitis is probably not preventable, although there is some indication that a diet high in green vegetables and tomatoes may help prevent appendicitis.

Resources
Periodicals
Van Der Meer, Antonia. "Do You Know the Warning Signs of Appendicitis?" Parents Magazine (April 1997): 49. Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved. Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

appendicitis /appendicitis/ (ah-pend-sitis) inflammation of the vermiform appendix.

acute appendicitis appendicitis of acute onset, requiring prompt surgery, and usually marked by pain in the right lower abdominal quadrant, referred rebound tenderness, overlying muscle spasm, and cutaneous hyperesthesia. chronic appendicitis 1. that characterized by fibrotic thickening of the organ wall due to previous acute inflammation. 2. formerly, chronic or recurrent pain in the appendiceal area, without evidence of acute inflammation. fulminating appendicitis that marked by sudden onset and usually death. gangrenous appendicitis that complicated by gangrene of the organ, due to interference of blood supply. obstructive appendicitis a common form with obstruction of the lumen, usually by a fecalith.

Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

appendicitis (

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n. Inflammation of the vermiform appendix. The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved. The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

appendicitis [pendistis] Etymology: L, appendere + Gk, itis an inflammation of the vermiform appendix, usually acute, that, if undiagnosed, leads rapidly to perforation and peritonitis. The inflammation is caused by an obstruction such as a hard mass of feces or a foreign body in the lumen of the appendix, lymphoid hyperplasia, fibrous disease of the intestinal wall, an adhesion, or a parasitic infestation. Appendicitis is most likely to occur in teenagers and young adults and is more prevalent in male patients. One kind

of appendicitis is chronic appendicitis. observations The most common symptom is constant pain in the right lower quadrant of the abdomen around McBurney's point, which the patient describes as having begun as intermittent pain in midabdomen. Rebound tenderness occurs at McBurney's point as well. Pain may also occur on the left side. Extreme tenderness occurs over the right rectus abdominis muscle. To decrease the pain, the patient keeps the knees bent to prevent tension of the abdominal muscles. Appendicitis is characterized by vomiting, a low-grade fever of 99 to 102 F, an elevated white blood cell count, rebound tenderness, a rigid abdomen, and decreased or absent bowel sounds. Other indications of peritonitis include increasing abdominal distension, acute abdomen, tachycardia, rapid and shallow breathing, and restlessness. If peritonitis is suspected, IV antibiotic therapy, fluids, and electrolytes are given. nursing considerations The nurse is alert to the signs and symptoms of rupture and peritonitis and provides education about the diagnosis, treatment, and recovery. interventions Treatment is appendectomy within 24 to 48 hours of the first symptoms because delay usually results in rupture and peritonitis as fecal matter is released into the peritoneal cavity. The fever rises sharply once peritonitis begins. The patient may have sudden relief from pain immediately after rupture, followed by increased, diffuse pain. Mosby's Medical Dictionary, 8th edition. 2009, Elsevier. Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.

appendicitis [ah-pend-sitis] inflammation of the vermiform APPENDIX, a serious disease that usually requires surgical removal (APPENDECTOMY). When performed early the operation is comparatively simple and safe. When the appendix becomes inflamed and infected, rupture may occur within a matter of hours. Rupture of the appendix leads to PERITONITIS, one of the most serious of all diseases, although its danger has been reduced by antibacterial agents. CAUSE. If the tubelike appendix becomes plugged by a hard bit of fecal matter or by intestinal worms, or becomes inflamed from other causes, normal drainage cannot take place. Because the appendix is chiefly lymphatic tissue, an infection that produces enlarged lymph nodes elsewhere in the body also can increase the glandular tissue in the appendix and obstruct its lumen. Narrowing of the lumen makes the pouchlike organ more susceptible to bacterial infection. Escherichia coli and other types of bacteria multiply and cause inflammation and infection that spread to the peritoneal cavity unless the body's defenses are able to overcome the infection or the appendix is removed before it ruptures. SYMPTOMS. The classic symptoms of appendicitis are pain, nausea, vomiting, and low-grade fever in adults. Children tend to have higher fevers. The pain typically begins in the umbilical region and eventually localizes in the right lower quadrant of the abdomen over the site of the appendix. The pain is persistent and is aggravated by motion, causing the patient to bend over and tense the abdominal muscles (muscle guarding). Rebound pain occurs when the abdomen is deeply palpated and the hand is quickly removed from the abdomen. The patient also can feel pain in the area of the appendix when either a rectal or pelvic examination is done. Other data that may support a diagnosis of appendicitis are obtained through a blood cell count. An elevated white cell count (leukocytosis) commonly accompanies appendicitis as it does other kinds of inflammation. Mild leukocytosis of 14,000 to 16,000 per mm3 is common. A white cell count higher than 20,000 per mm3 suggests a ruptured appendix and peritonitis. Other diseases that can be mistaken for appendicitis are gallbladder attacks and kidney infection on the right side. The onset of pneumonia, rheumatic fever, or diabetic ketoacidosis can imitate appendicitis. In women, there is the possibility of a ruptured ectopic pregnancy, a twisted ovarian cyst, or a hemorrhaging ovarian follicle at the middle of the menstrual cycle. PATIENT CARE. When appendicitis is suspected because of symptoms exhibited by the patient, a health care provider should be notified immediately. The patient should lie down and remain as quiet as possible. It is best to give him

nothing by mouth, and because of the danger of aggravating the condition and possibly causing rupture of the appendix, cathartics and laxatives are contraindicated. Applications of heat and the administration of laxatives or enemas are contraindicated for the same reasons. After the patient has been assessed and a diagnosis of appendicitis has been established, appendectomy will probably be performed as soon as possible. During the preoperative phase it may be necessary to hydrate the patient with intravenous fluid therapy, especially when there has been prolonged nausea and vomiting. Decompression of the intestinal contents by suction via a nasogastric tube is also necessary in some cases. Postoperative care is usually uneventful. The exception is when there has been a ruptured appendix; this serious condition warrants diligent and aggressive nursing care to overcome the effects of peritonitis with the resultant shifting of body fluids, hypovolemia (which can be life-threatening), and septic shock. Antibacterial drugs are administered to combat the infection. Gastric and intestinal decompression is maintained, and most surgeons advocate intraperitoneal draining by means of Penrose drains in order to prevent formation of abscesses and promote healing. The most common complications of appendectomy and peritonitis are (1) infection of the surgical wound, (2) paralytic ileus due to irritation of the small bowel, (3) abscesses, and (4) obstruction and adhesions. Ongoing assessment of the patient includes observing the type and amount of drainage from the intestinal tract via the nasogastric tube and from the Penrose drain in the wound; appearance of the surgical incision; dressings applied and the frequency with which they are changed; evidence that bowel function is returning to normal, e.g., presence of bowel sounds, passing of flatus and fecal material; measurement of intake and output; tolerance of foods and liquids once the nasogastric tube is removed and decompression discontinued; and tolerance for physical activity, coughing and deep breathing, positioning, and postoperative exercises. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. appendicitis, n an inflammation of the vermiform appendix, usually acute, which, if undiagnosed and not surgically removed, leads rapidly to perforation and peritonitis. Mosby's Dental Dictionary, 2nd edition. 2008 Elsevier, Inc. All rights reserved. Mosby's Dental Dictionary, 2nd edition. 2008 Elsevier, Inc. All rights reserved. appendicitis inflammation of the vermiform appendix. Occurs in humans and the great apes. The syndrome includes abdominal pain, fever and leukocytosis. Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007 Elsevier, Inc. All rights reserved Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007 Elsevier, Inc. All rights reserved appendicitis Surgery Inflammation of the vermiform appendix which is most common in children Clinical Right lower quadrant pain of acute onset, rebound tenderness over McBurney's point in right hypogastrium, fever, anorexia, constipation, diarrhea, N&V Lab WBCs, left shift of WBCs, ESR Diagnosis Hx, PE, ultrasound, CT Management Appendectomy Complications Rupture, purulent peritonitis; untreated, death. See Appendix. Cf Left-sided appendicitis. McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc. McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc. Patient discussion about Ruptured appendix. Q. how can i differentiate between normal stomach ache and an Appendicitis? I've been having a strange sharp pain in my stomach lately and a friend of mine told me it could be Appendicitis. A. When you have Appendicitis, there should be a sharp pain on the right lower Abdomen. but you mustn't forget that Appendicitis is an inflammation. which means you'll have a fever some time in the near future, and it always get

worse. not like other Abdominal pains. you'll vomit probably. i had my Appendix removed 2 years ago. don't worry, it's not too bad ;). Q. What Causes Acute Appendicitis? I've heard that appendicitis is a very common situation. What causes it to happen? Is there a way to avoid it? A. Appendicitis is caused by an infection of the appendix, usually from bacterias that are already located in the abdomen. It is not a situation that can be avoided and can occur in a high prevalence in the population. Q. What is Acute Appendictis? My husband had to go to the emergency room last night because of sudden severe stomach aches. The doctors said he had acute appendictis and needed urgent operation. What is acute appendicitis? A. The term 'Appendictis' refers to an inflammed appendix, an organ that is located in the right lower part of the abdomen, attached to the cecum, which is a part of the intestine. The appendix is often infected with intestinal bacteria, and such an infection can cause severe symptoms, that require receiving emergent medical care. If indeed acute appendicitis is diagnosed, the treatment involves immediate surgery, for the removal of the infected appendix.