Appendicitis (Acute)

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ICD10 CODE: K35-K37

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)

Management

TREATMENT

LOC

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 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)

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