Acute Appendicitis Part-A.Clinical features.for Medical stds BPT, BMRIT students. скачать в хорошем качестве

Acute Appendicitis Part-A.Clinical features.for Medical stds BPT, BMRIT students.

Acute Appendicitis is a common cause of pain abdomen. It occurs due to inflammation of the appendix generally due to obstruction of its lumen due to faecolith. The obstruction causes stagnation of mucous secretions which gets infected with resultant obstruction of blood supply due to venous and arterial thrombosis which results in necrosis or even gangrene of appendix and spread of infection into peritoneal cavity and may present as generalized peritonitis in case the gangrenous appendix perforates. Acute appendicitis presents as periumbilical pain shifting to right iliac fossa with tenderness at Mcburney's point in a typical case however in locations of appendix in retrocaecal, pelvic, or paracaecal or pre or post ideal position, acute Appendicitis may present with pain in right loin in retrocaecal position , or loose stools in case infllamed appendix touches the rectum or may cause urinary symptoms if it touches ureter or urinary bladder. In situs inversus the appendix may be located on left side and therefore pain may be sited in LLQ. In typical appendicitis there will be tenderness af McBurney's point as infllamed appendix touches the parietal peritoneum. The patient will have rebound tenderness too and Rovsing sign, Psoas test and obturator test will be present accordingly. Diagnosis of Acute Appendicitis depends upon history and clinical examination and confirmed by Alvarado score and investigations like Ultra Sound which will demonstrate the lumen of appendix more than 6 mm and incompressible lumen. CECT will confirm the diagnoses. Acute Appendicitis is best managed by open or laparoscopic appendectomy after resuscitation unless lump forms. TLC count is raised with shift to left. Nausea or vomiting after the onset of pain is common. Anorexia and elevated temperature are common. Appendicular lump is best managed by conservative Ochsner Sherren regime with intravenous fluids and antibiotics and interval appendectomy after four weeks. One may complicate operating upon a patient with appendicular lump as the adherent friable caecum is liable to be perforated. Neglected appendicitis may result in perforation and peritonitis with significant morality. KINDLY WAIT FOR PART-II