diease

Appendicitis


OVERVIEW OF Appendicitis :

Appendix is an finger shaped organ that is present in the lower right side of the intestine.The inflammation of the appendix is termed as the appendicitis.Reginaldz fidzz is the first person to rule out the disease.

Appendix:It is located in right side of the intestine.It harbours gut bacteria.And this bacteria helps the digestive system to rebound from infections.Some prefer that appendix is an useless organ.But the presence of appendix boost your immune system and studys suggest that the person is 4 times lesser the risk for crohns disease when his appendix is not removed. Appendicitis occurs when there is a blockage in the appendix by mucus,stool, a growth or combination of both may take place.

   Delaying the treatment might result is rupture of the organ.


EPIDEMIOLOGY :

It is more common in men and the age group affected includes 5-40 years of age.


CAUSES :

Fibre rich diet prevents appendicitis

Obstructions such as faecolith,stricture,threadworm

Abuse of purgatives.

Certain viruses,Bacteria and parasites

Luminal obstruction.

 


PATHOPHYSIOLOGY :

The primary pathogenic event in most of patients with acute appendicitis is believed to be due to luminal obstruction. This may result from a variety of causes, which include fecaliths, lymphoid hyperplasia, foreign bodies, parasites, and by both primary (carcinoid, adenocarcinoma, Kaposi sarcoma, and lymphoma) and metastatic (colon and breast) tumors. Fecal stasis and fecaliths characterize the most common cause of appendiceal obstruction, followed by lymphoid hyperplasia, vegetable matter and fruit seeds, barium from previous radiographic studies, and intestinal worms (especially ascarids) . The prevalence of appendicitis in teenagers and young adults suggests a pathophysiologic role for lymphoid aggregates that exist in abundance in the appendix of this age group . According to this theory, obstruction leads to inflammation, rising intraluminal pressures, and ultimately ischemia. Subsequently, the appendix enlarges and incites inflammatory changes in the surrounding tissues, such as in the pericecal fat and peritoneum. If untreated, the inflamed appendix eventually perforate.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Pain starts in the center part of the tummy. The pain travels to the right lower side of the tummy where usually the organ lies.

Coughing, walking or doing strenuous exercises worsen the symptoms.

Fever

Tachycardia

Foetor oris

ConstipationUrinary frequency


DIAGNOSTIC :

Raise in temperature >37.3°C

Total blood count:Leucocyte count is increased (WBC count-greater than 10,000-12,000 cells/mm3

Laproscopy is the best choice for detecting the inflammation in the appendix

CT sacn – it detects the appendix and also reveals if any perforation is present.

The Alvarado scoring system:It says the risk of appendicitis in patients. And it is applicable in paediatric patients also.

A Score of 1:elevated temperature >37.3°C, rebound tenderness, migration of pain to right lower quadrant (RLQ), anorexia, nausea or vomiting, and leukocyte increase.

A score of 2 :for RLQ tenderness and leukocytosis >10 000.

 A score of 5 or 6 :“compatible” with the diagnosis of acute appendicitis and recommends the clinician observe or serially examine the patient.

A score of 7 or 8 : “probable” appendicitis

A score of 9 or 10 is “very probable” appendicitis and recommends surgical intervention

C-reactive proteins:It is used to detect the complicated appendicitis.It levels are raised within 8-12 hours of time period after the onset of inflammmateory process and the peak reaches within 24-48 hours.

Granulocyte count and proportion of Polymorpho Nucleocytes: Normal level-2000-6000 cells Elevated levels 7-7.5*109  cellls/L

Biological Markers:Interleukin 6, serum Amyloid protein A,Ribonucleogram,Plasma cytokines,Calproctin


TREATMENT AND PROGNOSIS :

The surgical procedure done to treat the appendix is called appendectomy.IT can be done by open technique or laproscopic technique.Laproscopy is preferred over open method since it has many advantages.

Open appendectomy:

It is the standard method of treatment.The surgeon makes incision in the right lower abdominal region,above the hip bone and removes the infected tissues and also the affected tissues in the surrounding region.In case of complicated removal such as if any abscess are present then the drainage tube is indicated to prevent further infection.

Laparoscopic appendectomy

It came into an act in 1983 and has many adavantages when comparing to the standard procedure. Laprascope ,a camera like device is placed near the incision region and the laprascope is connected to the monitor which is present outside to inspect the abdominal region. Then the incision is made and infection is removed.The main advantage of this

technique includes immediate post operative recovery,less pain during the surgery and formation of intra abdominal abscess is reduced with this technique.

 

Pre-surgery

The patient is made to restrain from the food and intravenous infusion is made to hydrate the patient. Antibiotics such as cefuroxime,Metrinidazole is given to the patient to sustain away the. treatment and benefit from serial examinations. If the stomach is empty that is no food in the past six hours  general anaesthesia is usually used. Orelse spinal anaesthasia is indicated in patients undergoing surgeris.

 If the appendix has not ruptured, the complication rate is only about 3% but if the appendix has ruptured, the complication rate rises to almost 59%.The most usual complications that can occur are pneumonia, hernia of the incision, thrombophlebitis, bleeding and adhesions.

In most cases, patients going in for surgery experience nausea and vomiting that require medication before surgery. Antibiotics, along with pain medication, and antiemetics may be administrated before appendectomies.


PROGNOSIS :

Without surgery or antibiotic treatment the prognosis is bad and it can lead to > 50% of fatality rate.

  • Complication of appendicitis:
  •  A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.
  • A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you're given antibiotics to clear the infection.


PREVENTION :

Take more amount of fiber rich diet

Fried foods and food rich in fat should be avoided

Alcohol harms the liver and it disturbs the digestion

Red meat contains lots of fat ,hence it should be avoided.

Take plenty of fluids

Avoid strenous exercises.

 


Recovery Period :

Laprascopic treatment requires shorter duration of time for recovery

 Usually the recovery time varies between 2-3 weeks.

The recovery time period also depends upons the indivduals degree of complication to the appendicitis.Hence recovery period varies from individuals


Medicines used in the Treatment :

Medicines used:Piperacillin and tazobactum,ciprofloxacin,metronidazole,levofloxacin.


REFERENCE :

SRB manual of General Surgery

http://cdc.in

http://ncbi.nih.in

 Bowers WF (1937). "Significance of the obstructive factor in the genesis of acute appendicitis". Archives of Surgery

Appendicitis Encyclopedia of SurgeryArchived from the original on 2010-02-09