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Appendicitis

more about Appendicitis




Normal

Abnormal
  • The appendix is a collection of lymphatic tissue (tissue that is part of the body's immune/defense system).  The appendix, connected to the colon, is a few inches in length and has a lumen (a hollow portion).  Appendicitis is thought to occur when this lumen becomes obstructed.

  • Pain usually begins near belly button
  • Pain then localizes to the right lower abdomen
  • Nausea/vomiting (occurs after pain starts and not before)
  • Loss of appetite
  • Urinary pain/frequency may occur
  • Flank, pelvic, or rectal pain may occur

  • Fecal obstruction
  • Parasitic worm obstruction
  • Tumor obstruction
  • Viral infection of appendix
  • Barium obstruction (from a medical test)

  • Examination:
    1. Fever
    2. Fast heart rate
    3. Rebound tenderness in right lower abdomen (pain is worse when doctor releases hand from abdomen)
    4. Flank, rectal, or pelvic pain if appendix is in unusual position
    5. Rigid or diffuse abdominal tenderness if appendix perforates
  • Laboratory:
    1. Laboratory tests may be unreliable in some (e.g., older patients with certain drugs/medications).
    2. Elevated white blood cell count
    3. Urinalysis to check for other causes
  • Imaging:
    1. Abdominal X-Ray (KUB), Ultrasound, or Barium Enemas may help in certain cases but are not diagnostic.
    2. Spiral CT scan is now very sensitive in detecting appendicitis

  • Surgical removal of the appendix (appendectomy) as soon as possible, unless the doctor feels a mass on the outside.
  • If mass is felt on the outside, patients are treated with IV antibiotics and fluids, and appendectomy is done when the patient is more stable.

  • Seek emergency medical care Immediately


  • Special Considerations
    1. There may be unusual presentations, such as pain in rectum only and no abdominal pain, if the appendix is pointed backwards.  Therefore, appendicitis must be considered as a possible diagnosis in all types of pelvic, rectal, and back pain, as well as with abdominal pain.
    2. In infants with fever, Diarrhea, vomiting, and abdominal pain appendicitis should always be considered.
    3. In elderly patients, appendicitis often presents with less severe pain.
    4. In pregnant women, appendicitis occurs in 1 in every 1000 pregnancies, and the enlarged uterus may push appendix to the right upper abdomen, causing pain in this area.




more about Appendicitis


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