Appendicitis

Appendicitis

1. Appendicitis Hamzeh Halawani M.D. American University of Beirut

2. Appendicitis 7% lifetime risk of developing appendicitis.  Peak at 10 and 30 years of age, but may occur in men and women of any age . Signs and Symptoms? Physical Exam?

3. Signs Dunphy sign: increased pain with any coughing or movement Rovsing sign: is RLQ pain that is induced by palpation of the left lower quadrant and is highly suggestive of a RLQ inflammatory process. The obturator sign: is seen with inflammation of a pelvic appendix and refers to pain on internal rotation of the right hip. The iliopsoas sign: is most often seen with a retrocecal appendix and refers to pain on extension of the right hip . Aure-Rozanova sign, Bartomier -Michelson's sign, Kocher's ( Kosher's ) sign, Massouh sign, and Sitkovskiy (Rosenstein)'s sign.

4. CT scan Enlarged appendix >6 mm in diameter Appendiceal wall thickness >2 mm Periappendiceal inflammation (fat stranding ) The presence of a fecalith Wall enhancment The presence of the arrowhead sign (thickened cecum funneling contrast toward the appendiceal orifice )  The risk of radiation-induced malignancy has been recently estimated at 0.18% following exposure to abdominal CT.

5. US Non compressable >6 mm in diameter Free fluid and abscess. fecalith

6. DDx inflammatory bowel disease Crohn's ileitis Gynecologic pathology ( mittelschmerz , salpingitis , ectopic pregnancy, tubo -ovarian abscess, and endometriosis ). gastroenteritis . diverticulitis Meckel's diverticulitis Renal Colic acute mesenteric adenitis. epiploic appendagitis , torsion, and thrombosis of a pedunculated adipose structure off the serosal surface of the cecum may resemble appendicitis but can be distinguished on CT scan. familial Mediterranean fever (FMF ). Yersenia infection TB

7. Open Vs. Lap Laparoscopic appendectomy leads to a shortened hospital stay for patients with uncomplicated acute appendicitis, less postoperative pain, faster return to work, and lower total cost of care.  Laparoscopic appendectomy was associated with a lower incidence of postoperative wound infection than open appendectomy was (3.5% versus 6.7%), but it was also associated with a higher incidence of postoperative intra-abdominal abscess (2.5% versus 1.1%). The length of stay was slightly shorter after laparoscopic appendectomy (1 to 4.9 days; average 2.7 days) than after open appendectomy (1.2 to 5.3 days; average 3.2 days)

8.  At present, however, the only patients for whom laparoscopic appendectomy appears to offer significant advantages are women of childbearing age Obese patients Patients with an unclear diagnosis.

9. Chronic appendicitis Pain last longer, same location, less intense. Much lower incidence of vomiting and nausea. WBC normal, CT not diagnostic. Appendectomy is curative.