Appendicitis

– An acute inflammation of the appendix.

Causes and Incidence

The etiology is not clear but appears to be related to obstruction of the appendiceal lumen by a fecal mass, stricture, or infection. Acute appendicitis is one of the most common reasons for abdominal surgery. The incidence is about 1 in 1,000 persons in the United States; the condition is most common in adolescents and young adults and is slightly more prevalent in men.

Disease Process

The lumen is obstructed, blood flow is diminished, hypoxia develops, the mucosa ulcerates, and bacteria invade the wall, causing an infection and producing edema, which further impedes blood flow, causing tissue necrosis, gangrene, and perforation.

Symptoms

The typical symptom is progressively severe abdominal pain, which begins in the midabdomen and shifts to the lower right quadrant after 6 to 10 hours. The pain may be accompanied by a low-grade fever, malaise, nausea, and vomiting.

Potential Complications

Perforation causes peritonitis.

Diagnostic Tests

Clinical examination
Localized rebound tenderness at McBurney’s point.

WBCs
Moderately elevated with left shift.

Laparoscopy
For visualization when diagnosis is in doubt.

Treatments

Surgery – Appendectomy.

Drugs – Antibiotics for prophylaxis after surgery.

General – None.

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