Appendicitis
Presented By: Shahad Elkanzi (1701659)
Supervisor Dr. Nino Gabunia
DEFINITION
• Appendicitis is an inflammation of
appendix that develops most common in
adolescents and young adults.
• Appendicitis is inflammation of the
appendix, and is the most common cause
for acute, severe abdominal pain.
• The abdomen is most tender at
McBurney's point - one third of the
distance from the right anterior superior
iliac spine to the umbilicus. This
corresponds to the location of the base of
the appendix
TYPES
• Acute Appendicitis:
• Acute appendicitis, as its name implies, develops very
fast, usually in a span of several days or hours. It is
easier to detect and requires prompt medical
treatment, usually surgery.
• Acute appendicitis occurs when the vermiform
appendix is completely obstructed, either because of a
bacterial infection, stool or other types of blockage.
Infection may also cause swelling of the lymph nodes,
which then adds pressure on the appendix, cutting off
its blood supply.
• The stages of appendicitis can be divided into early,
suppurative, gangrenous, perforated, phlegmonous,
spontaneous resolving, recurrent, and chronic.
• Appendicitis Can Be Chronic (But It's a Rare
Condition)
• Chronic appendicitis is an inflammation that can last
for a long time. it only occurs in only 1.5 percent of
recorded acute appendicitis cases.
• Basically, chronic appendicitis means that the
appendiceal lumen is only partially obstructed,
causing inflammation. The inflammation worsens
over time, causing internal pressure to buildup.
• Stump Appendicitis: A Rare Appendectomy Side
Effect
• If the appendix has already ruptured, additional
treatment measures are performed during an
appendectomy, as the infection needs to be
prevented from spreading.
RISK FACTORS
• Infection, possibly stomach infection that has
traveled to the site of appendix.
• Obstruction such as a hard piece of stool
getting trapped in the appendix leading to
infection of the appendix.
• Extreme of age
• Previous abdominal surgery
Etiology
• More common in young man, white races, less fiber diet.
• Family history
• Obstruction of the appendiceal lumen typically by lymphoid hyperplasia
but occasionally by a fecalith, foreign body, or even
• The obstruction leads to distention, bacterial overgrowth (appendix to
become inflamed, swollen and filled with pus), ischemia & rupture.
CAUSES
• It's not clear what causes appendicitis. In many cases it may be that
something blocks the entrance of the appendix.
• For example, it could become blocked by a small piece of stool , It called
fecolith .
• upper respiratory tract infection could cause the lymph node within the
wall of the bowel to become swollen.
• If the obstruction causes inflammation and swelling, it could lead to
increased pressure within the appendix, which may then burst.
• Tumors
• Trauma
Signs and symptoms of appendicitis
• Sudden pain that begins around umbilicus
(due to distension of appendix) and after
few hour shifts to right iliac fossa.
• Pain that worsens if you cough, walk or
make other movements
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that may worsen as the
illness progresses
• Urinary frequency
• Constipation or diarrhea if appendix is in
postileal or pelvic position)
Important signs in appendicitis
• Rovsing's sign: Palpating in the left lower
quadrant causes pain in the right lower
quadrant
• Psoas sign: RLQ pain with extension of the right hip or
with flexion of the right hip against resistance.
• Baldwing test: Retrocecal appendicitis, pressure is
applied in the right lower quadrant. lift the right leg
with the knee straight. drop the leg.
• Rebound tenderness: Elicited by
deep palpation of the abdomen
followed by the sudden release of
the examining hands
• obturator's sign: Internal rotation
of the hip causes pain, suggesting
the possibility of an inflamed
appendix located in the pelvis!
Diagnosis
• Physical exam to assess your pain-
apply gentle pressure on the painful
area. When the pressure is suddenly
released, appendicitis pain will often
feel worse.
• Blood test- high white blood cell
(leucocyte) count.
• Urine test- urinary tract infection or a
kidney stone
• Imaging tests-
Abdominal X-ray (Plain or barium
enema)
Abdominal ultrasound
CT scan
MANAGEMENT
• Surgery is indicated if appendicitis is diagnosed.
• To correct or prevent fluid and electrolyte imbalance
and dehydration, antibiotics and intravenous fluids are
administered until surgery is performed.
• Analgesics can be administered after the diagnosis is
made. (Morphine sulphate 10 mg/ml)
• Antibiotics
• Cefotaxime 250mg, 500mg
• Levofloxacin 500 mg
• Metronidazole 500mg/100ml, 400 mg tablet
Surgical management
• Open appendectomy- mc-burneys incision
• Laparoscopic appendectomy
PRE-OP PREPARATION
• INVESTIGATION
• Urinalysis- exclude infection
• Full blood count- leucocytosis
• Ultrasound scan - noncompressible
diameter of > 6mm
• Rehydrate patient with IV fluids; N/S O
Pass urethral catheter
• N-G tube
• IV antibiotics prophylaxis- broad spectrum
ANAESTHESIA
• General anesthesia with
endotracheal intubation and
muscle relaxation
• Local anesthesia may be
indicated in the very ill
patient.
• Patient is placed in supine position.
• Routine scrubbing and gowning
• The skin is cleaned from the nipple line to the
POSITION mid-thigh and draped exposing the operation
field.
INCISION
• The incision is placed at the point of maximum tenderness.
• APPROACHES;
• Mc Burney's/Grid iron; Right angle to a line joining ASIS
and Umbilicus at 2/3 the distance from the umbilicus, 1/3
above and 2/3 below the line. Avoid too medial/too lateral.
• Lanz; skin crease incision. Cosmetically better
approximately 2 cm below the umbilicus centred on the
mid-clavicular-midinguinal line.
• Rutherford Morison's ; muscle cutting. The muscles are cut
upwards and laterally- cutting the internal oblique and
trasversus abdominis- extension of Mc Burney
Laparoscopic Appendectomy
• We make three small incisions in the
abdomen, through which particular
instruments are inserted. A gas is gently
pumped into the abdominal cavity to separate
the abdominal wall from the organs. This
makes it easier to examine the appendix and
internal organs.
• We Do Laparoscopic Surgery To remove
Appendix. It is a minimal invasive surgery and
thus Recovery is faster than open surgery.
Open appendectomy
1. Traditional approach is Gridiron incision over McBurney's
point, at 90° to line from umbilicus to the anterior
superior iliac spine. Lanz incision is more horizontal in
Langer's lines (skin creases) and gives a better scar.
2. Divide subcutaneous fat and superficial/Scarpa's
fascia.Fibers of external oblique, internal oblique and
transversus abdominus divided with muscle splitting
incision.
3. Incise pre-peritoneal fat and peritoneum to reveal
caecum.Deliver caecum through incision. Appendix
located at convergence of taenia coli.
4. Mesoappendix (blood vessels and mesentery) and
appendix divided, ligated and excised (stump may be
inverted).
5. In case of a normal looking appendix, excise (may be
histologically if not macroscopically inflamed); look for
Meckel's diverticulum.
6. Wash, close in layers, dress wound.
• In uncomplicated case, oral
fliud are started 12hrs after
recovery followed by light diet
POST-OPERATIVE 24hrs later.
MANAGEMENT • In complicated, IV fluids, IV
antibiotics and NPO with NG
tube drainage until bowel
activity recommence and
temperature subsides
• Stiches removed in 7-10days
• Wound infection
• Intra-abdominal abscess
• Haemorrhage
• Ileus
Postoperative • Generalised peritonitis
Complications of • Respiratory infections
Appendicectomy • UTI
• Adhesive intestinal obstruction
• Respiratory - pneumonitis or collapse
• Venous thrombosis and embolism
• Portal pyaemia (pylephlebitis)
• Stool fistula
Reference:-
• https://www.healthline.com
/health/appendectomy#What-is-an-appendectomy
• https://www.mayoclinic.org
/diseases-conditions/appendicitis/symptoms-causes/
syc-20369543
• https://www.webmd.com
/digestive-disorders/picture-of-the-appendix
• https://www.hopkinsmedicine.org
/health/conditions-and-diseases/appendicitis
• https://www.msdmanuals.com
/home/digestive-disorders/gastrointestinal-emergencies/appendi
citis
• https://www.verywellhealth.com
/what-does-the-appendix-do-5270731
• https://medlineplus.gov/ency/article/000256.htm
• Schwartz's Principles of Surgery, 10th Edition
