Acute appendicitis
Defination
Appendicitis is an
inflammation of
the appendix a
small, finger like
pouch attached to
the large intestine.
Incidence
The
incidence of
acute
appendicitis
has declined
from
3.6/10,00
among
preschooter
From 18.6/10,000
to 6.8/10,000 in
children aged 5-9
years.
From
29.2/10,00
0 to
19.8/10,00
0 in
children
aged 10-14
years.
ETIOLOGY
• Obstruction of the lumen of the
appendix.
• Viral infection.
• Enterobius vermicularis or pinworms.
• Faecoliths.
• Submucosal lymphoid hyperplasia.
OLbstruction of the lumen of the
appendix.
Viral infection
Enterobius
vermicularis or
pinworms.
Faecoliths
Submucosal
lymphoid
hyperplasia
Risk factors
Age- appendicitis is the most common in
people between the ages of 10 and 30, but it
affects people of any age.
Sex- appendicitis is more commen in men
then in women. Sex-
Family history- People with a family history of
appendicitis are at a higher risk of developing
it especially children.
Diet- A diet high in processed foods and low
in fiber can increase the risk of constipation
and hard stools, which can obstruct the
appendix.
Pathophysiology Due to etiological factor
Acute obstruction, the out flow of mucus
secretion is blocked and pressure builds
within the lumens.
Compression Of blood vessels.
Ischemia.
Ulceration of the epithelial lining and
bacterial invasion.
Subsequent necrosis causes perforation or rupture with
fecal and bacterial contamination of the peritoneal cavity.
Inflammation spreads rapidly throughout the abdomen
lperitonitis.
Progressive peritoneal inflammation.
Intestinal obstruction of the small bowel.
Imbalance and hypovolemic shock.
Clinical manifestations of
appendicitis-
• Right lower quadrant abdominal
pain.
Fever Rigid abdomen
Anorexia Vomiting
Rapid shallow Tachycardia clinical
breathing manifestations
Irritability Stopped posture
Diagnostic evaluation-
• Complete blood count
(CBC)
A high WBC count is often found in
people with appendicitis. WBC count of
more than 10,500 cell/ul
• Urinalysis
Urinalysis may
be useful in
differentiating
appendicitis from
urinary tract
conditions.
• Ultrasound of abdomen-
The most useful
finding on
ultrasonography that
is suggestive of
appendicitis is an
outer appendiceal
diameter of 6mm or
Ct scan
MRI-
MR imaging of
the abdomen has
been shown to
be as effective in
diagnosing
appendicitis.
Management
Medical
management
Antibiotics- Antibiotics are administered
intravenously to children with suspected
appendicitis to slow the infection and prevent
appendix from progressing. The most
• Ampicillin
common regimen is a combination of
• Clindamycin
• Gentamicin
• Ceftriaxone 1gm Iv twice daily to prevent infe
IV Fluid- normal saline to correct
dehydration and maintain fluid
balance.
• Surgical management
Laproscopic appendectomy
A minimally
invasive surgical
procedure to
remove the
appendix through a
few small incisions
Procedure
The surgeon makes a few small incisions in the
abdomen, usually near the belly button and
above the pubic area.
2. The surgeon inserts a laparoscope through
one of the incisions to see the appendix.
3. The surgeon inserts a tube to pump carbon
dioxide into the abdominal cavity to make
more room to work.
1. 4. The surgeon inserts surgical instruments
5. The surgeon uses the instruments to
remove the appendix
6. The surgeon closes the incisions with
stitches or a stapling device
7. The surgeon covers the incisions with
liquid skin glue or Steri-strips
