Appendicitis.jpg
CT scan showing appendicitis

Definition

[1]
Acute Appendicitis (also known as appendicitis) in inflammation of the veriform appendix at the base of the caecum due to obstruction.

Incidence

[2]
About 7.5% lifetime risk

Age

10-40

Gender

Slightly higher risk in males (8.6 vs 6.7%)

Aetiology

[3]
  • A stool
  • Hyperplastic lymph tissue

Risk Factors

[4]
  • Young Age
  • Smoking/ Exposure to passive smoke

Signs and Symptoms

[5]

Pathophysiology

[6]
After the appendix is obstructed, the lumen of the appendix becomes filled with mucous and causes distension. Distension causes visceral pain referred to the periumbilical region, as well as reflex nausea and anorexia. When the pressure of the lumen exceeds the venous pressure, blood pools and inflammation involving the serosa and parietal peritoneum occurs. This causes somatic pain in the right lower quadrant. The appendix may also become ischaemic eventually leading to infarction and perforation. Perforation often occurs close to the base of the appendix rather than the tip.
Investigations

[7]

Diagnosis

[8]
Diagnosis can usually be made clinically but a CT can be used in more complicated cases.

Differentials to rule out

Treatment

[9]
Non-Pharmacological
  • Supportive Care

Pharmacological

Surgical

  • Appendectomy

Management

[10]
If patients present two weeks after onset of pain then it is not always appropriate to operate. They may be monitored on the ward, sent home and asked back for appendectomy 4-6 weeks later (Interval appendectomy).
Patients should be followed up 1 week after operation to check for development of complications. Patients can be started on a full diet one day after operation provided there is no nausea or vomiting. No long term follow up is required if there are no complications.

Complications

[11]
  • Perforation and Peritonitis
  • Gangrene
  • Abscess
  • Surgical Wound Infection

Prognosis

[12]
If the patient is treated quickly then prognosis is very good.

See Also

BMJ Best Practice - Acute Appendicitis

Citation

CT Appendicitis image: "CAT scan demonstrating acute appendicitis" by James Heilman, MD - Own work. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:CAT_scan_demonstrating_acute_appendicitis.jpg#/media/File:CAT_scan_demonstrating_acute_appendicitis.jpg
  1. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  3. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  5. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  11. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html
  12. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/290.html