Appendix

Appendix
Acute Appendicitis
Age 20 - 30 yrs (If old age suspect malig) Diet High protein diet predisposes to constipation stasis & infection. Causative organism E.coli, staph, strept Route of infection Lumen, rarely lood & lymph

Predisposing Factors
Obstruction !ue to hard faeces, adhesion, "in", o#yuriasis, $.%., tumors. Anatomical factors &arro' lumen, 'all rich in lymphoid follicles .

Pathology
A. Acute obstructive Appendicitis (2/3 of cases)
(. )atarrhal inflammation mucocele. 2. *uppurati+e pyocele or empyema 3. ,angrenous inflammation

B. Acute non obstructive appendicitis ( /3 of cases)

)atarrhal, *uppurati+e, ,angrenous

Complications
General *epticemia, to#emia, Local
. Appendicular !ass
It is a locali-ing process y greater omentum to pre+ent spread of infection, needs ./ hrs (guided y chemotactic material) Fate of Appendicular Mass : (. 0sually it resol+es 'ithin fe' 'ee"s. 2. 1ppendicular a scess. Fate of Appendicular Abscess point on a dominal 'all, or +agina or urst into peritoneal ca+ity generali-ed peritonitis. Position of appendicular abscess & mass Depends on position of appendix acteremia or pyemia.

2. Diffuse peritonitis

Computerized By: Yahia Makkeyah

If perforation 2 ./ hours, 3ucocele pseudomy#oma peritonii. 4mpyema or gangrenous type diffuse suppurati+e peritonitis. 1ppendicular a scess. (5./ hrs points rupture). In non o structi+e type 1

3. C"ronicit#

Appendix

)678 !yspepsia due to refle# pylorospasm.

Clinical Picture
a. Symptoms
General: $.1.H.3. ($e+er is of lo' grade). Local.
. $ain )olic"y in o structi+e type .
1- At first:
,enerali-ed mar"ed around the um ilicus

- After fe! hours

locali-ed in right iliac fossa at 3ac%erney9s point

"- Pain in the epi#astrium due to refle# pylorospasm 2. %istor# of recent constipation is common 3. &ausea' vomiting 3ore in o structi+e type (once or t'ice) (. Anore)ia is al'ays present

b. General Examination )%. ut fe+er not mar"ed c. Local Examination $more e%ident on Mc&urne'(s point)
(. 2. <. :igidity 3. ,uarding .. 1ppendi# may e felt on 7.:.. :e ound tenderness ; intestinal mo+ement.

Special Signs

Rovesing sign pressure on Lt iliac fossa pain on :t iliac fossa %#peraest"esia of triangle of *"eren +ac"ar# cope fle#ion, internal rotation of hip =oint pain in hypogastrium $soas test 7atient fle#es right hip if appendi# in contact 'ith muscle. Blumburg,s sign >n & of pr. on Lt iliac fossa pain in :t iliac fossa. a. Appendicular massHistory from 2-3 days. ?emp. 5 3/o), more tachycardia & +omiting. 3ass might e felt b. Appendicular abscess- History from <-@ days A *, * of pus loculus c. $eritonitis- History of appendicitis, $e+er 5 3/), *igns of diffuse peritonitis

Picture of complications

Atypical forms
. Retro caecal ./0. 7ain is minimal, %ut it might touch ureter
ureteric colic, loin pain & may e hematuria 2. $elvic 210 7ain in pel+is, 1ppendi# felt in 7.:

3. $aracaecal 0. (. $ost ileal 0.<B ?ouch ileum diarrhea then constipation

Computerized By: Yahia Makkeyah

Appendix

/. *ub "epatic as acute cholecyctitis ut pt. is young & hyperaesthesia

in usual site.

Investigation )%. A leucocytosis, 0rine analysis. Treatment

. Acute appendicitis 2 Appendectom#. 2. Appendicular mass 2 (Oschner-Sherrens) then appendectomy after 3 m.
3"at is Osc"ner4*"erren5s regimen 6 (. *emi sitting position 2. :yle 3. Intra+enous fluids, 1nti iotics .. Hot fomentation <. $ollo' up chart, 3ar" of the mass to follo' it. @. $ollo' up of a dominal signs.

3. Appendicular abscess C (complicated mass)

(. 2. 3. .. 3uscle cutting incision 4#traperitoneal drainage In pel+ic a scess 'e drain through +agina, 1ppendectomy after 3-@ months.

(. Diffuse peritonitis CB(

ifferential diagnosis
Abdominal conditions
(. 2. 3. .. 7erforated peptic ulcer 1cute cholecystitis 1cute pancreatitis Intestinal o struction <. &on specific lymphadenitis @. :egional ileitis. D. 3ic"el9s di+erticulum. /. Intestinal o struction

$elvic conditions
E. (0. ((. (2. (3. (.. !istur ed right ectopic pregnancy 1cute salpingitis 3id - cyclic pain ( mittleschmert- ) ?'isted right o+arian cyst from appendicular mass :ight ureteric colic. ?onsil tummy in children !ia etic a domen (<. 7neumonia

Retroperitoneal conditions C"est condition Ot"ers

(@. (D. 7eriodic peritonitis

Tumors of the Appendix

Carcinoid (Argantafinoma)
1rise in argantafin tissue, >ne of 170!omas Locally malignant, metastasi-es in .B of cases ,olden yello' in colour Early cases no flushing, or ronchospasm

Computerized By: Yahia Makkeyah

Appendix

Late cases infiltration of posterior a dominal 'all symptoms occurs. ?reated y appendectomy if 2 (.< cm, & y right hemicolectomy if 5 (.< cm

Adenocarcinoma
Less freFuent. It secretes mucin & can cause pseudomy#oma peritonii. :t. Hemicolectomy is done.

7#mp"oma

Computerized By: Yahia Makkeyah