RESEARCH WORK IDENTIFICATION SHEET

Qualification ACUTE APPENDICITIS

Names and surnames Student code
COLQUE TERRACES Albaro 40850
MACHACA ARUQUIPA Ismael 41824
MAMANI RIOS Vanesa 201501119
Author/s PAUCA PAREDES Arnold Alexander 38729
RAFAEL VILLCA Diana 39746
ROMERO COLQUE Julio Cesar 30045
RODRIGUEZ CADIMA NELLY 201303670
CUBAS PERRALTA KELLY Brigith 5589058
Date 27/06/2020
Career MEDICINE
Subject GASTROENTEROLOGY
Cluster A–B
teacher SULLCA CLAROS WALTER
Academic I – 2020
period
Sub- COCHABAMBA
headquarters

.
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

SUMMARY:

Appendicitis is an inflammation of the appendix, which has a finger-shaped pouch

that projects from the colon on the lower right side of the abdomen.
Appendicitis causes pain in the right lower abdomen. However, in most people, the
pain starts around the belly button and then moves. As the inflammation worsens,
appendicitis pain usually increases and eventually becomes severe.
Appendicitis is caused by a blockage inside the appendix. This blockage causes
increased pressure, problems with blood flow, and inflammation. If the blockage is not
treated, the appendix can rupture and spread the infection to the abdomen .

Keywords: inflammation – pain – dissemination – blockage

ABSTRACT:
Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects
from the colon on the lower right side of the abdomen.
Appendicitis causes pain in the lower right abdomen. However, in most people, the
pain begins around the navel and then travels. As the inflammation worsens, the pain of
appendicitis usually increases and eventually becomes intense.
Appendicitis is caused by a blockage inside the appendix. This blockage causes an
increase in pressure, problems with blood flow and inflammation. If the blockage is not
treated, the appendix may rupture and spread the infection to the abdomen.

Key words: inflammation – pain – dissemination - blocking

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Table of Contents

Introduction.................................................................................................................................4
Chapter 1. Problem Statement....................................................................................................5
1.1. Problem formulation..................................................................................................5
1.2. Goals..........................................................................................................................5
1.3. Justification................................................................................................................5
Episode 2. Theoretical framework..............................................................................................6
2.1 Acute appendicitis.........................................................................................................6
2.1. Epidemiology...................................................................................................................6
2.2. Etiology............................................................................................................................6
2.3. Pathophysiology........................................................................................................6
2.6. Diagnosis.................................................................................................................10
2.7. Treatment.................................................................................................................11
2.8. Postoperative Complications...................................................................................11
Chapter 3. Method.....................................................................................................................13
3.1 Kind of investigation...................................................................................................13
3.2 Research techniques....................................................................................................13
Chapter 4. Results and discussion.............................................................................................14
Chapter 5. Conclusions.............................................................................................................15
Reference ias.............................................................................................................................16
Appendix...................................................................................................................................17

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Introduction

Acute appendicitis is the main cause of acute surgical abdomen. It consists of the
inflammation and subsequent infection of the cecal appendix, a small sac located in the large
and 3rd centuries
intestine. Its prevalence is highest between the 2nd . and 4th stage of life, it is
important to fully understand its anatomy, pathophysiology and evolution in order to make the
diagnosis and provide timely treatment.
Its diagnosis continues to be largely clinical, the questioning and physical examination are
vital, which is why most of the signs and symptoms to be found during the evolution of the case
will be broadly described. However, when the diagnosis is doubtful or an atypical or masked
condition occurs, we must rely on laboratory tests and office tests to confirm the diagnosis.
Furthermore, these studies help us to carry out differential diagnoses, since we can often be
confused with other pathologies such as ectopic pregnancies, pharyngotonsillitis, otitis, among
others.
During childhood, the function of the appendix is the production of defense cells, but
throughout life it loses this function. Sometimes the origin of the inflammation of the appendix is
unknown. One of the explanations is the presence of foreign bodies that cause obstruction,
subsequently producing a decrease in oxygenation in the appendix tissue, ulceration and
subsequent invasion of bacteria.
Patients diagnosed with acute appendicitis should be hospitalized and evaluated by a surgical
specialist, who will perform surgical management. Appendectomy involves the removal of the
cecal appendix through a small incision in the lower right region of the abdomen. After a
generally uncomplicated intervention, the person can eat within 24 to 36 hours and return to
daily activities in less than two weeks. If the patient presents peritonitis, the surgical wound
should be longer and located in the middle of the abdomen, allowing the abdominal cavity to be
cleaned.
Acute appendicitis is a very frequent cause of clinical cases in emergencies in Bolivian
hospitals in Cochabamba, which is why we investigated this issue of acute appendicitis.

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Chapter 1. Problem Statement

1.1. Problem formulation

What are the main causes of Appendicitis?

1.2. Goals

General objectives
 Address Appendicitis from different theoretical frameworks with structural,
functional, biological and cellular bases, which allow us to determine, understand and
explain its behavior and interactions in the human organism.

Specific objectives
 Achieve a general overview of the disease to be consulted through exhaustive
bibliographic documentation.
 Carry out an analysis from biology based on the changes that are generated at a
physiological level which lead to the occurrence of Acute Appendicitis.
 Determine the symptoms and signs associated with acute appendicitis
 Determine appropriate treatment for appendicitis.

1.3. Justification

It is considered that 7% of the general population is affected and it can occur at all ages,
however, it is rare at the extremes of life, where mortality is higher due to the difficulty of
diagnosis and because the body suffers from a good defense system.
Appendicitis can occur at any age, although the peak incidence of acute appendicitis occurs
most frequently in people between 20 and 30 years of age in which, except for strangulated
hernias, it is the most common cause of sudden, intense abdominal pain and of emergency
abdominal surgery in many countries. It is also an important cause of pediatric surgeries,
frequent in preschoolers and schoolchildren with a certain predominance in boys and a family
predisposition.
The appendectomy rate is approximately 12% in men and 25% in women. In the general
population, appendectomies for appendicitis occur in 10 out of every 10,000 patients each year
and mortality rates are less than 1 per 100,000 patients each year. 1970.

The incidence of appendicitis rises gradually from birth, peaks in late adolescence, and
gradually declines in the geriatric years. The average age when appendicitis occurs in the
pediatric population is 6-10 years. Lymphoid hyperplasia is seen more frequently among
children and adults, and is responsible for the increased incidence of appendicitis in these age
groups. Younger children have a higher rate of perforation, with rates between 50-85%. The
average age of appendectomy is 22 years. Although rare, neonatal and prenatal appendicitis have
been reported.

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Episode 2. Theoretical framework

2.1 Acute appendicitis

“Appendicitis” is a word derived from the Latin word apendix (appendix) and the Greek
suffix itis (inflammation), etymologically it means inflammation of the ileocecal appendix. (1)
It is the inflammation of the appendix or vermiform, which begins with obstruction of the
appendiceal lumen, which results from intraluminal pressure due to the accumulation of mucus
associated with poor elasticity of the serosa. (2)
2.1. Epidemiology

Acute appendicitis continues to be the major cause of acute abdomen requiring surgical
treatment. The lifetime risk of developing appendicitis is 67%. The peak of incidence is during
the second and third decades of life, and it is rare in children under five or over 50 years of age.
It occurs more frequently in males, being 1 in 35 affected and 1 in 50 in female patients. After 70
years of age the risk of developing appendicitis is 1%. In youth the average presentation is 3:1
between men and women. However, there has been an important variation in the incidence
between various countries, probably varying due to racial, occupational and mainly dietary
differences, since the greater presence of appendicitis has been demonstrated in countries where
fiber consumption is low. (3)
2.2. Etiology

In 85% of cases, inflammation of the appendix is secondary to an obstruction of the

appendiceal lumen, caused by the presence of a fecalith or lymphoid hyperplasia. Other much
less common causes of obstruction are: remains of vegetables or seeds, remains of barium from
previous studies, appendicular torsion, the presence of ascarids and tumors, such as carcinoid. In
the remaining 15% the cause is unknown. (5)

2.3. Pathophysiology

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

The pathophysiology of acute appendicitis continues to be enigmatic, however there are

several theories that attempt to explain this pathology. The most accepted by surgeons describes
an initial phase that is characterized by obstruction of the appendiceal lumen caused by lymphoid
hyperplasia, fecaliths, tumors or foreign bodies such as small animal bones or seeds; This favors
the secretion of mucus and bacterial growth, then generating luminal distension and increased
intraluminal pressure. Subsequently, obstruction of lymphatic and venous flow occurs, further
favoring bacterial growth and triggering the production of edema. (4)
At this time we find an edematous and ischemic appendix, causing a response
Inflammatory. This ischemia to which the appendix is subjected can generate necrosis of the
wall with bacterial translocation, developing gangrenous appendicitis. If this process is allowed
to evolve and the patient is not operated on, the already gangrenous appendix perforates and can
generate an abscess with local peritonitis as long as the inflammatory response and the omentum
manage to contain the process, but if these are unable, systemic peritonitis will occur. .(4)
Other theories have been described such as compromise of the extrapendicular vascular
supply, ulceration of the mucosa due to viral infection and subsequent bacterial colonization, as
well as a low-fiber diet with slowing of intestinal transit and retention of feces in the appendix,
and it may also be be caused by low daily water consumption. (4)

2.4. Causes
The cause of appendicitis is a blockage in the lining of the appendix that results in infection.
The bacteria multiply rapidly and cause the appendix to become inflamed, swollen, and filled
with pus. If not treated immediately, the appendix can rupture.

2.5. Clinical Picture

The diagnosis of acute appendicitis continues to be clinical, a well-developed clinical history,
as well as a good physical examination give the diagnosis in which morbidity and mortality
increase considerably; Under this situation, an atypical presentation of appendicitis can occur in
children under two or over 60 years of age. Included in this same category of atypical conditions
are altered or anatomically modified anatomical presentations such as: pregnancy, a long

Subject: Internal Medicine- Gastroenterology

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 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

appendix that is located in the right iliac fossa or an appendix with a subhepatic location or
simply situs inversus. (3)
In the initial stage of appendicitis, pain increases over the course of 12 to 24 hours and occurs
in 95% of patients with this entity. Pain is mediated by visceral pain afferent fibers; It is
characterized by being poorly localized in the epigastrium or periumbilical level, occasionally as
if it were a cramp that does not improve with evacuations, rest or a change in position. At this
stage, more than 90% of adult patients present anorexia, as do 50% of pediatric patients,16 and
of the total, 60% will present nausea. With this exception in adults: a patient who has an appetite
should cast doubt on the diagnosis. Diarrheal stools in adults are rare, being more common in
children. Six to 12 hours after the onset of the condition, the inflammation of the appendix
extends to the organs that surround it and the parietal peritoneum, which is why the pain is
located at Mc Burney's point. 25% of patients present pain located in the right lower quadrant
from the beginning of the clinical picture without presenting visceral symptoms. J.B. Murphy
was the first to emphasize the order of occurrence of symptomatology: “Symptomology occurs
in the majority of cases and when the order varies, the diagnosis must be questioned.” As in
everything there are exceptions; However, if nausea or fever occurs first, the diagnosis is not
appendicitis.(3)

 During the general inspection, the patient is kept in an antalgic position; temperature
elevation from 37.5 to 38 °C is common; However, 20-50% of patients maintain a
normal temperature.
 Axillary and rectal temperature, giving value to the difference greater than 1 degree.
Acute appendicitis may be suspected.
 Abdominal palpation shows positive rebound, voluntary and involuntary abdominal
resistance, in some conditions a plastron can be palpated. In women, rectal and vaginal
examination are mandatory, since they are necessary for differential diagnosis.(3)
Among the maneuvers, painful points and signs described are the following:

Subject: Internal Medicine- Gastroenterology

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Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

1. Mc Burney's painful point: Painful point on palpation at the junction of the middle
and lower third when drawing an imaginary line between the navel and the right iliac
crest.
2. Morris point: Painful point at the junction of the middle third and the inner third of
the right spinal umbilicus line. It is associated with the retroileal location of the
appendix.
3. Lanz Point: Painful point at the convergence of the interspinal line with the external
edge of the right rectus femoris muscle. It is associated with the location of the
appendix in the pelvic cavity.
4. Lecene Point: Painful point approximately two centimeters above and outside the
anterior superior iliac spine. It is associated with the retrocecal location of the
appendix.
5. Sumner's sign: Involuntary defense of the abdominal wall muscles over an area of
intraperitoneal inflammation. It is more objective than pressure pain and occurs in
90% of cases.
6. Blumberg's sign: Pain in the right iliac fossa upon decompression. It occurs in 80% of
cases.
7. Mussy sign: Pain on decompression in any part of the abdomen. It is a late sign of
appendicitis since it is considered phase IV appendicitis at this time.
8. Rovsing's sign: Pain in the right iliac fossa when compressing the left iliac fossa, it is
explained by the displacement of gases by the explorer's hand from the descending
colon to the transverse, ascending colon and cecum, which when dilated is mobilized,
producing pain in the inflamed appendix.
9. Psoas sign: The hand is gently placed on the right iliac fossa until it causes mild pain
and is moved away until the pain disappears. Without removing it, the patient is asked
to raise the right lower limb without bending the knee; The psoas muscle
approximates its insertions and widens its muscular part, mobilizing the cecum and
projecting it against the hand that is resting on the abdomen, which causes pain. It is
suggestive of a retrocecal appendix. (3)

Subject: Internal Medicine- Gastroenterology

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 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

10. Obturator sign: The hip is flexed and the knee is placed at a right angle, performing an
internal rotation of the lower extremity, which causes pain in the case of a pelvic-
located appendix.
11. Dieulafoy's appendicular triad: Consists of cutaneous hyperesthesia, abdominal pain
and muscle contracture in the right iliac fossa.
12. Klein maneuver: With the patient in the supine position, the most painful abdominal
point is marked, the patient's position is changed to the left lateral decubitus and the
painful point is pressed again. For acute appendicitis the painful point remains the
same and the patient flexes the right pelvic limb, for lymphadenitis the painful point
changes.(3)
13. Talus sign percussion: Pain in the right iliac fossa with the patient supine when
slightly raising the right pelvic limb and tapping the heel lightly.
Even though it is not described as such, tachycardia is an excellent marker of the severity of
the process and is characteristic of perforated appendicitis with Response Syndrome.
Severe inflammatory. (3)
2.6. Diagnosis

-Clinical:
Despite the multiple diagnostic methods currently available, the clinical history focused on
the evolution of pain and associated symptoms as well as the findings obtained during the
physical examination are still the cornerstones of the diagnosis of appendicitis. (4)
-Laboratory:
a) Hemogram
The usual finding in pediatric patients with appendicitis is a leukocytosis above 15,000
cells/mm• with predominance of neutrophilia. The data suggestive of urinary tract infection in
the general urine examination is the presence of more than 20 leukocytes per high-power field or
positive nitrites.
There is the so-called triple test that highly suggests the presence of appendicitis in the
presence of a suggestive clinical picture, a CRP above 8 mcg/ml, leukocytosis above 11,000 and
neutrophilia above 75%.

Subject: Internal Medicine- Gastroenterology

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 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Leukocytosis is usually present normally in pregnancy, reaching levels of up to 16 thousand

leukocytes or more during childbirth, so it is not considered specific; The presence of
neutrophilia and bands that accompany leukocytosis at levels up to 16 thousand cells/ml can
make us suspect the diagnosis but is not confirmatory of it.
Elevation of C-reactive protein levels is also not specific for a diagnosis of appendicitis;
However, levels above 55 mg/l have been found in patients with perforated appendicitis.
During pregnancy, the general urine examination in cases of appendicitis is usually normal.
The Red Formula, liver function tests and general urine examination do not present alterations
during the appendiceal condition but it is advisable to request them to rule out pathology at
another level.(3)
b) urine
Urinalysis is usually requested to exclude the possibility of urinary tract infection when it is
suspected, and pyuria and/or hematuria without bacteriuria may be found in one third of patients
with appendicitis due to the proximity of the ureter and the bladder.
2.7. Treatment

The indicated treatment for acute appendicitis is appendectomy. Although it is an urgent

intervention, the surgical and anesthetic risk must be assessed, so it is very important to optimize
the patient's physical conditions as much as possible in case of comorbidities.
(especially cardiopulmonary). (5)
There are 2 surgical treatments: open appendectomy and laparoscopic appendectomy. There is
still controversy about the optimal type of treatment. Only in specific cases, the laparoscopic
route is proven superior: in obese patients, where a lower rate of surgical wound infection has
been demonstrated, and in women of childbearing age in whom there are doubts about the
diagnosis, where the best vision of the entire abdominal cavity allows other diagnoses to be
excluded (exploratory laparoscopy). In practice, the choice of one of the techniques depends on
the experience of the surgeon and the resources of the hospital. (5)
2.8. Postoperative Complications

Complications after surgery include paralytic ileus, wound infection, pneumonia, intra-
abdominal abscess formation (especially in perforated AA), and abdominal hemorrhage. (5)

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
Title: Acute Appendicitis
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Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Chapter 3. Method

3.1 Kind of investigation

The research is DESCRIPTIVE type. It addresses the topic of acute appendicitis and this is
described in different aspects such as:
- Physiology
- Pathology
- How it affects the different population at the local, national and international level.

The design is DOCUMENTARY type.

The design is of a documentary type since books related to pathology, physiology and cell
biology were consulted and read, scientific articles on Gastroenterology through which the
search was focused on information and articles that were recent as well as books specialized in
the topic of gastroenterology and physiology of latest editions.

3.2 Research techniques

The documentary research technique focuses its main function on all those procedures that
entail the optimal and rational use of the documentary resources available in information
functions.

Among the most common files, the main ones are described and exemplified:

 Bibliographic File (book).

 Hemerographic File (magazine article, newspaper)

Subject: Internal Medicine- Gastroenterology

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 Title: Acute Appendicitis
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Chapter 4. Results and discussion

From the theoretical research carried out in this work, it was possible to cover the proposed
topic (Acute Appendicitis) from different texts that allowed the pathophysiology of said disease
to be detailed.
Furthermore, with this excellent bibliographical help, it was possible to visualize Appendicitis
as a biological and cellular process, which for reasons of a self-harming nature triggers a whole
series of clinical and symptomatic manifestations, typical that allow the doctor to recognize and
treat in a timely manner in order to resume these interactions. altered cell-cell.

Also the analysis carried out by the members of this thematic exploration, allowed us to
capture the clearest and most concise concepts with which any student of the same or lower
semesters can feel comfortable when reading them, understanding them in a simple way and with
some very good quotes. that will allow the expansion of that information if greater self-learning
is desired.

The theories provided are the following:

- In 85% of cases, inflammation of the appendix is secondary to an obstruction of the

appendiceal lumen, caused by the presence of a fecalith or lymphoid hyperplasia. Other
much less common causes of obstruction are: remains of vegetables or seeds, remains of
barium from previous studies, appendicular torsion, the presence of ascarids and tumors,
such as carcinoid. In the remaining 15% the cause is unknown.

- In the initial stage of appendicitis, the pain increases over the course of 12 to 24 hours
and is characterized by being poorly localized in the epigastrium or at the periumbilical
level, occasionally as if it were a cramp that does not improve with evacuations, rest or a
change of position. position.

- The indicated treatment for acute appendicitis is appendectomy. Although it is an urgent

intervention, the surgical and anesthetic risk must be assessed, so it is very important to
optimize the patient's physical conditions as much as possible in case of comorbidities.

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
 Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Chapter 5. Conclusions

Acute appendicitis is the first cause of acute surgical abdomen, therefore, it is important
to know how to assess and diagnose this pathology in time in order to provide definitive
treatment, since the delay in its diagnosis will be reflected in an increase in morbidity and
mortality. of the patient.
Appendicitis occurs when the appendix becomes blocked. It can also occur in the case of
an infection in the appendix. Obstruction or infection can cause inflammation of the appendix,
causing pain.
In the semiological diagnosis of appendicitis, the anamnesis and physical examination are
very important to reach a syndromic diagnosis. The anamnesis (the most important part being the
writing of the current illness since it offers us up to 80% of the syndromic diagnosis we are
looking for) will give us a diagnostic presumption based on the data reported by the patient,
which is why it is of utmost importance to the doctor. It is important to know how to apply it, the
most important thing being to know how to listen, pay attention and guide the patient in case
they deviate in the report of their discomfort.
Likewise, performing the physical examination with its respective maneuvers is very
important to corroborate a diagnostic presumption. Inspection, palpation, percussion and
auscultation play a very important role in the physical examination since these can indicate
possible injuries or signs that the patient may have forgotten to report. The maneuvers performed
at the abdominal level will also be of great help for the diagnosis, since depending on the
patient's response to performing these maneuvers, they will help us determine if our possible
diagnosis made with the anamnesis can be true or not. It could be another possible clinical
condition.
As already mentioned, the diagnosis is clinical and the laboratories and office studies are
only supportive, which is why it is vitally important to recognize the entity and put into practice
some of the more than 30 appendicular maneuvers described in the literature that will contribute
to rule out most pathologies from the differential diagnosis.
The treatment of acute appendicitis is surgical and the technique used will vary
depending on the criteria of each surgeon and the clinical stage.

Subject: Internal Medicine- Gastroenterology

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 Title: Acute Appendicitis
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Reference ias

1. http://www.monografias.com/trabajos92/apendicitis/apendicitis.shtml
2. Mexican Institute of Social Security 031-08. Diagnosis of acute appendicitis-clinical
practical guide.
3. Dr. Roberto Carlos Rebollar Gonzalez, Rc and Cols. (2009). Acute appendicitis:
4. Literature review.
5. Jorge fallas gonzalez (2012). Literature review of acute appendicitis, vol. 29(1) ISNN.
6. Oriol Crusellas, Jaume Comas, Oscar Vidal and G. Benarroch.(2008). Management and
treatment of appendicitis

Subject: Internal Medicine- Gastroenterology

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Title: Acute Appendicitis
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Appendix

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18
Title: Acute Appendicitis
Author(s): Colque-Cubas-Machaca-Mamani-Pauca-Rafael-Romero-Rodriguez

Subject: Internal Medicine- Gastroenterology

Career: Medicine Page18 of 18