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    Acute Appendicitis

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    Mukhtar Khan
    The document discusses the presentation and diagnosis of acute appendicitis. It covers the aetiology, pathology, clinical features, investigations, differentials, and Alvarado's scoring system used to diagnose appendicitis. The pathology involves bacteria initiating infection in the appendix lumen, leading to inflammation, ulceration, and potentially gangrene or perforation. Clinical features include abdominal pain shifting to the right lower quadrant, loss of appetite, nausea, and fever. Investigations include blood tests, urinalysis, ultrasound, and CT scan. Differentials include other causes of abdominal pain like intestinal obstruction or pneumonia. Alvarado's score is used to evaluate the likelihood of appendicitis.

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    Acute Appendicitis

    Uploaded by

    Mukhtar Khan
    209 views17 pages
    The document discusses the presentation and diagnosis of acute appendicitis. It covers the aetiology, pathology, clinical features, investigations, differentials, and Alvarado's scoring system used to diagnose appendicitis. The pathology involves bacteria initiating infection in the appendix lumen, leading to inflammation, ulceration, and potentially gangrene or perforation. Clinical features include abdominal pain shifting to the right lower quadrant, loss of appetite, nausea, and fever. Investigations include blood tests, urinalysis, ultrasound, and CT scan. Differentials include other causes of abdominal pain like intestinal obstruction or pneumonia. Alvarado's score is used to evaluate the likelihood of appendicitis.

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    Acute Appendicitis

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    The document discusses the presentation and diagnosis of acute appendicitis. It covers the aetiology, pathology, clinical features, investigations, differentials, and Alvarado's scoring system used to diagnose appendicitis. The pathology involves bacteria initiating infection in the appendix lumen, leading to inflammation, ulceration, and potentially gangrene or perforation. Clinical features include abdominal pain shifting to the right lower quadrant, loss of appetite, nausea, and fever. Investigations include blood tests, urinalysis, ultrasound, and CT scan. Differentials include other causes of abdominal pain like intestinal obstruction or pneumonia. Alvarado's score is used to evaluate the likelihood of appendicitis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    209 views17 pages

    Acute Appendicitis

    Uploaded by

    Mukhtar Khan
    The document discusses the presentation and diagnosis of acute appendicitis. It covers the aetiology, pathology, clinical features, investigations, differentials, and Alvarado's scoring system used to diagnose appendicitis. The pathology involves bacteria initiating infection in the appendix lumen, leading to inflammation, ulceration, and potentially gangrene or perforation. Clinical features include abdominal pain shifting to the right lower quadrant, loss of appetite, nausea, and fever. Investigations include blood tests, urinalysis, ultrasound, and CT scan. Differentials include other causes of abdominal pain like intestinal obstruction or pneumonia. Alvarado's score is used to evaluate the likelihood of appendicitis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    Presentation and Diagnosis of Acute Appendicitis

    Dr Bakhtiar Alam PG, GS - III

    Aetiology

    Unclear Luminal obstruction Diet Familial factors Multifactorial

    Pathology

    Bacteria in the lumen initiate infection Small ulcer (due to impacted faecilith) Inflammation sets in oedema of the wall purulent inflammation leading to thrombosis and gangrene Greater omentum or small intestine adhere to appendix and localises sepsis

    Patho Contind

    Generalized peritonitis results if perforation occurs

    Clinical features

    50 % have classical presentation Its a mobile structure, clinical pic. Is dictated by the anatomical position of the inflamed organ Abdominal pain, initially central, colicky in obstructive appendix and constant in nonobstructive Pain shifts to RIF as inflammation involves the parietal peritoneum, agg. by movement and coughing

    Loss of appetite , constipation and nausea may have vomiting On/Ex.


    Pt. is flushed with dry tongue Mild pyrexia Slight tacycardia Tender RIF esp. McBurneys point with rigidity, tenderness on percussion Rebound tenderness offers no added help Rovsings sign PR and vaginal exam. May be normal

    Anatomical features influencing presentation

    Rectocaecal appendix

    Tenderness to deep plapation is lacking and muscular rigidity absent Rt. Hip slightly flexed due to psoas spasm Passive extension or hyperextension of the hip increases the abdominal pain

    Post-ileal

    Symptoms are vogue and pain is poorly localized Vomiting more persistent Diarrhoea more frequent

    Pelvic

    Diarrhoea Increased freq. of micturation, microscpic haematuria Rectal of vaginal examination may localize tenderness in the rectovaginal pouch Psoas spasm Passive internal rotation of Rt. Hip may aggravate pain (obturator sign)

    Age related features influencing presentation

    Young Children

    Non specific presentation difficult to differentiate from mesenteric adenitis and enteritis Delay in diagnosis and short greater omentum results in higher rates of peritonitis, perforation and abscess formation

    Elderly

    Symptoms less pronounced, May be afebrile Normal white cell count Delayed treatment resulting in higher rates of perforation Diminished physiological reserves Increased mortality

    Pregnancy

    Displaced appendix, Atypical presentaion Nausea/vomiting more pronounced Tenderness on Rt. Side abdomen, not marked US abdomen is helpful Risk of fetal death is 10% (UK) Perforation significantly increases risk to the mother and fetus (mortality 2% and 30% respect.)

    Investigations

    Ix helpful in variable presentation CP


    Leucocytosis in about 90% Predominantly neutrophils Usually normal Leucocytes or red cells in urine in retrocaecal and pelvic appendicitis

    Urinalysis

    Pregnancy test in all women of reproductive age Radiology

    AXR to exclude other cuases Usual findings but not specific, haziness in RIF, dilated distal ileal loops
    Can be used in atypical hx and to exclude other pathology

    US abdomen

    Ix

    Laparoscopy

    Good visualization of abdomen and pelvis Helpful in atypical presentation, esp young women Rarely required to make diagnosis

    CT abdomen

    DDs

    Thorax

    Pneumonia Intestinal Obstruction Ac. Cholecystitis Perf. Peptic ulcer Gastroenteritis Mesenteric adenitis Terminal ileitis Meckels diverticulitis

    Abdomen

    DDs

    Pelvic

    Urinary System

    Ectopic pregnancy Ruptured ovarian follicle Torted ovarian cyst Salpingitis/ PID Rt. Pyelonephritis Rt. Ureteric colic DKA, Rectus sheath haematoma, Pancreatitis, preherpatic pain on the Rt. 10th and 11th dorsal nerves

    Others

    Alvarados score

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