Sandbox:Aditya: Difference between revisions
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===Surgery=== | ===Surgery=== | ||
'''Emergency appendectomy''' | |||
Indicated in the treatment of | |||
*Perforated appendicitis, especially in patients with life-threatening signs of peritonitis, | |||
*In patients with a large appendiceal abscess, | |||
*In patients with an extraluminal appendicolith. | |||
===Photodynamic therapy=== | ===Photodynamic therapy=== | ||
===Miscellaneous therapies=== | ===Miscellaneous therapies=== |
Revision as of 18:52, 15 February 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Synonyms and keywords:
Overview
An appendicular abscess is unusual and rare entity and a life threatening complication of acute appendicitis. It is seen in 2-7% of population presenting with appendicitis.
Historical Perspective
Classification
Pathophysiology
The eight functional compartments in the peritoneal cavity include the following:
- Pelvis
- Right paracolic gutter
- Left paracolic gutter
- Right infradiaphragmatic space
- Left infradiaphragmatic space
- Lesser sac
- Hepatorenal space (Morrison space)
- Interloop spaces between small intestine loops
Periappendiceal abscesses from a perforated appendix may develop in the right lower quadrant.
Transmission
The abscesses usually contain a mixture of aerobic and anaerobic bacteria from the gastrointestinal tract.
Differentiating appendicular abscess from other abscess
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Epidemiology and Demographics
The lifetime risk of appendicitis is 8.6 % for males and 6.7 % for females; however, the risk of undergoing appendectomy is much lower for males than for females (12 vs. 23 %) and it occurs most often between the ages of 10 and 30, with a male:female ratio of approximately 1.4:1.
Screening
Natural History, Complications, and Prognosis
Natural history
Complications
Prognosis
Diagnosis
History
The key to an efficient and accurate diagnosis is a detailed and thorough history. The following information should be obtained:
- Onset, location, radiation, and duration of pain;
- Aggravating or relieving factors;
- Severity of pain (constant or intermittent);
- Characteristics of the pain;
- History of the pain;
- Association with nausea, vomiting, anorexia, or diarrhea;
- Time of last bowel movement; and
- Recent use of analgesics, narcotics, or antibiotics.
Symptoms
Physical examination
Laboratory findings
Treatment
No universal standard treatment exists for appendicitis complicated by abscess. The preferred treatment includes non-operative management such as drainage and broad spectrum IV antibiotics followed by interval appendectomy with high success rates up to 97% and low incidences of complications.
Medical Therapy
Antibiotic therapy must have broad spectrum activity towards both gram-negative and anaerobic pathogens.
Empiric therapy
Monotherapy with a beta-lactam/beta-lactamase inhibitor:
- Ampicillin-sulbactam :3 g IV every six hours
- Ticarcillin-clavulanate :3 g IV every four hours
- Piperacillin-tazobactam :3 g or 4.5 g IV every six hours
Combination third generation cephalosporins PLUS metronidazole
- Ceftriaxone : 1 g IV every 24 hours (plus)
- metronidazole : 500 mg IV every eight hours.
Alternative empiric regimens
Combination fluoroquinolone◊ PLUS metronidazole:
- Ciprofloxacin (or) : 400 mg IV every 12 hours
- Levofloxacin (plus) : 500 or 750 mg IV once daily
- Metronidazole : 500 mg IV every eight hours
Monotherapy with a carbapenem
- Imipenem-cilastatin : 500 mg IV every six hours
- Meropenem : 1 g IV every eight hours
- Doripenem : 500 mg IV every eight hours
- Ertapenem : 1 g IV once daily
Surgery
Emergency appendectomy Indicated in the treatment of
- Perforated appendicitis, especially in patients with life-threatening signs of peritonitis,
- In patients with a large appendiceal abscess,
- In patients with an extraluminal appendicolith.