Appendicitis (Acute)
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Inflammation of the appendix.
Causes
- Blockage of the appendix duct with stool or particles, followed by infection by intestinal bacteria
Clinical features
- Constipation (common)
- Pain situated around the umbilicus
- Crampy, keeps on increasing in severity
- After some hours, the pain is localised in the right iliac fossa and becomes continuous
- There may be nausea and vomiting
- Fever (low grade in initial stages)
- Tenderness and rigidity (guarding) in right iliac fossa
- Generalized abdominal pain and signs of peritonitis follows rupture when the contents are poured into the abdominal cavity
Differential diagnosis
- Salpingitis (in females), ovarian cyst
- Ectopic pregnancy
- Pyelonephritis, ureteritis (inflammation of the ureter)
- Intestinal obstruction
Investigations
- No special investigations - good history and physical examination are essential for diagnosis
- Complete blood count: look for leucocytosis
- Transabdominal ultrasound
- Abdominal X ray (to assess for perforation and intestinal occlusion)
ManagementTreatment
- Emergency surgery
- If surgery is delayed, start antibiotic treatment while referring
- ceftriaxone 2 g IV once daily
- Child: 80 mg/kg IV once daily
- plus metronidazole 500 mg IV every 8 hours
- child 10 mg/kg IV every 8 hours
- ceftriaxone 2 g IV once daily
- Start antibiotic prophylaxis before the surgery and continue for a duration depending on the findings (< 24 hours for unperforated appendix, at least 5 days for perforated appendix)