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acute appendicitis

An inflammation of vermiform appendix caused by festering microflora. It is seen more common among people 10 to 30 years old. It leads to more emergency abdominal surgeries. The luminal capacity of the normal appendix is only 0.1 mL. Inflamed appendix will likely burst if not removed (especially, gangrenous appendicitis). Bursting spreads infection throughout the abdomen, leading to peritonitis. The inflammatory process in children is very quick. Even half a day from the occurring, there can appear its destruction, even perforation. In old people, the pain sensitiveness is decreased. The sclerosis of vessels of appendix results in its rapid numbness, initially, gangrenous appendicitis develops, the destructive forms of appendicitis prevail (appendiceal infiltrate). Pregnant women (especially in the second half of pregnancy) have more possibility to cause this for bend of appendix and violation of its blood flow, for increased uterus in size, that displaces caecum together with appendix upwards and an overdistension abdominal wall does not create adequate tension. They can periodically have a moderate pain in the abdomen and changes in the blood test. Together with that, psoas-symptom and the Bartomier's symptom are good to see for diagnosis. Symptoms: 1. Anorexia nervosa (loss of appetite). 2. Constipation or diarrhea with gas. 3. Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. (Usually on of the first sign.) 4. Nausea, vomiting (soon after abdominal pain begins). 5. Low-grade fever: 37.2 - 38.9 oC. Abdominal swelling. They are caused by obstruction of the appendiceal lumen: Feces (fecaliths), festering microbes (e.g. streptococcus, staphylococcus), inspissated barium from previous x-ray studies, tumors, vegetable and fruit seeds, etc. Enlarged lymph tissue in the wall of the appendix, caused by infection. Inflammatory bowel disease (Crohn's disease and ulcerative colitis). Trauma to the abdomen. Complications: Appendiceal infiltrate: Conglomerate of organs and tissue not densely accrete round the inflamed vermiform appendix. It develops, certainly, on 3-5th day from the beginning of disease. Acute pain in the stomach calms down, thus, the general condition of a patient gets better. It is treated by appendectomy. Appendicular abscess: A collection of pus resulting from necrosis of the tissue superimposed with infection in an inflamed appendix. It is life-threatening. Plastron appendicitis: An abscess formation that occurs when the appendix is surrounded by the omentum following perforation of acute appendicitis. Diffuse peritonitis. Pylephlebitis. Diagnosis: Physical exam to assess the pain. Blood test (e.g. complete blood count, c-reactive protein test): Abnormal rise indicates infection or inflammation. In pregnancy, elevation of WBCs may be normal. Urine test: To rule out the urinary tract infection or a kidney stone as the source of the pain. Imaging tests (e.g. X-ray, ultrasound, CT scan, MRI). Treatment: Open appendectomy: During a laparoscopic surgery, if the appendix has burst and infection has spread, you may need an open appendectomy. Treatment includes cleaning of the abdominal cavity to remove bacteria to avoid peritonitis and usually intravenous antibiotics at least for the first few days. Laparoscopic appendectomy: Compared to an open appendectomy, less invasive, less pain and scarring, shorter hospital stay and recovery time, and lower infection rates. Antibiotic therapy (e.g. amoxicillin + clavulanic acid, cefotaxime, or a fluoroquinolone, often with metronidazole or tinidazole, in the total duration of 8 to 15 days.): One of the choice over immediate appendectomy considering the harm-benefit balance.