Appendicitis is a condition characterized by inflammation of the appendix.

It is classified as amedical emergency and many cases require removal of the inflamed appendix, either bylaparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock. Reginald Fitz first described acute and chronic appendicitis in 1886, and it has been recognized as one of the most common causes of severe acute abdominal pain worldwide. A correctly diagnosed non-acute form of appendicitis is known as "rumbling appendicitis". The term "pseudoappendicitis" is used to describe a condition mimicking appendicitis

Signs and symptoms

Pain first, vomiting next and fever last has been described as the classic presentation of acute appendicitis. Since the innervation of the appendix enters the spinal 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). In case of a retrocecal appendix (appendix localized behind the cecum), however, even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix), the reason being that thececum, distended with gas, protects the inflamed appendix from the pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point) and this is the least painful way to localize the inflamed appendix. If the abdomen on palpation is also involuntarily guarded (rigid), there should be a strong suspicion of peritonitis, requiring urgent surgical intervention.

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. Atypical histories lack this typical progression and may include pain in the right lower quadrant as an initial symptom. Atypical histories often require imaging with ultrasound and/or CT scanning.A pregnancy test is vital in all women of child bearing age, as ectopic pregnancies and appendicitis present similar symptoms. The consequences of missing an ectopic pregnancy are serious, and potentially life threatening. Furthermore the general principles of approaching abdominal pain in women (in so much that it is different from the approach in men) should be appreciated.

Pediatrics (also known as paediatrics or pdiatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician, paediatrician, or pdiatrician. The word pediatrics and its cognates mean healer of children; they derive from two Greek words: (pais = child) and (iatros = doctor or healer). In the United States, a pediatrician (US spelling) is often a primary care physician who specializes in children, whereas in the Commonwealth a paediatrician (British spelling) generally is a medical specialist not in primary general practice History Pediatrics is a relatively new medical specialty, developing only in the mid-19th century.Abraham Jacobi (18301919) is known as the father of pediatrics because of his many contributions to the field. He was born in Germany, where he received his medical training, but later practiced in New York City. Soranus of Ephesus in Greece in the 2nd century AD wrote the first known manuscript devoted to pediatrics. Rhazes (865925) in Persia wrote a work entitled The Diseases of Children. The first printed book on pediatrics was in Italian (1472) Bagallarder'sLittle Book on Disease in Children. In the Western world, the first generally accepted pediatric hospital is the Hpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage. From its beginning, this famous hospital accepted patients up to the age of fifteen years and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merger with the physically contiguous Necker Hospital, founded in 1778. This example was only gradually followed in other European countries. The Charit (a hospital founded in 1710) in Berlin established a separate Paediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (nowWrocaw), both in 1837. The English-speaking world waited until 1852 for its first paediatric hospital, the Hospital for Sick Children, Great Ormond Street, some fifty years after the founding of its namesake in Paris. In the USA, the first similar institutions were theChildren's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).