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{{Appendicitis}}
{{Appendicitis}}
{{CMG}}; {{AE}} {{CP}} {{MM}}
{{CMG}} {{AE}}


==Overview==
==Overview==
''Appendicitis'' is a condition characterized by [[inflammation]] of the [[Vermiform appendix|appendix]].  While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by [[laparotomy]] or [[laparoscopy]]. In untreated cases, mortality is high mainly due to [[peritonitis]] and [[Shock (medical)|shock]]. Appendicitis is usually accompanied by [[Abdominal pain|abdominal pain]], [[Ddx:Anorexia|anorexia]], [[Ddx:Fever|fever]], and [[Ddx:Nausea and Vomiting|nausea or vomiting]]
Appendicitis is a condition characterized by [[inflammation]] of the [[appendix]] and is the most common abdominal surgical emergency. Symptoms of appendicitis include a brief history of [[Nausea and vomiting|nausea]], [[anorexia]], and generalized [[abdominal pain]] with an eventual migration of the pain to the [[Right lower quadrant abdominal pain resident survival guide|right lower quadrant]]. [[Fever]] (higher than 37.3°C) is more often present in [[infants]] and young children. [[CT]] is considered the diagnostic imaging test of choice for suspected appendicitis. [[Perforation]] of an [[Appendicitis|inflamed appendix]] is seen in 15% to 25% of all patients treated surgically, with the highest rates seen in young children and elderly patients. Treatment of appendicitis depends on whether the patient presents with simple [[inflammation]] of an [[Appendix Normal|intact appendix]] or with a [[Peritonitis|perforated appendix]] with or without [[Appendicular abscess|abscess]]. Definitive treatment for patients with appendicitis is an [[appendectomy]]. Nonoperative treatment with [[antibiotics]] and expectant observation is an option for pediatric patients. If left untreated, [[mortality]] is high mainly due to [[peritonitis]] and [[Shock (medical)|shock]].


==Historical Perspective==
==Historical Perspective==
Appendicitis was first officially described by Reginald J. Fitz of Harvard University in 1886. Since that time, the [[appendectomy]] has become one of the most common surgical procedures of our time. The [[laparoscopic]] appendectomy was invented in 1980, and has led to reduced length of hospital stay, a decreased risk of [[infection]], and a reduction in post-operative pain.
Appendicitis was first officially described by Reginald J. Fitz of Harvard University in 1886. Since that time, the [[appendectomy]] has become one of the most common surgical procedures. The [[laparoscopic]] appendectomy was invented in 1980, and has led to reduced length of hospital stay, a decreased risk of [[infection]], and a reduction in post-operative pain.


==Classification==
==Classification==
Appendicitis may be classified at three levels. As appendicitis often results from appendiceal [[obstruction]] leading to [[necrosis]] and [[infection]], it may be classified based on the cause of the the obstruction. It also can be classified based on the [[organism]] causing this infection, or on whether it is perforating or non-perforating.
Appendicitis may be classified at two levels. As appendicitis often results from appendiceal [[obstruction]] leading to [[necrosis]] and [[infection]], it may be categorized based on the cause of the obstruction or on whether it is perforating or non-perforating.


==Pathophysiology==
==Pathophysiology==
Appendicitis is caused by the obstruction of the [[Lumen (anatomy)|tubular space]] inside the [[appendix]].  This initial problem is compounded into a cascade of events that lead to the [[inflammation]] of the [[appendix]], the [[obstruction]] of the blood vessels supplying it, and [[infection]].  Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components. If the disease is not treated, eventually the appendix will rupture and can lead to death.
Appendicitis is caused by the obstruction of the [[Lumen (anatomy)|tubular space]] inside the [[appendix]].  This initial problem is compounded into a cascade of events that lead to the [[inflammation]] of the [[appendix]], the [[obstruction]] of the blood vessels supplying it, and [[infection]].  Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components. The appendix will rupture and can eventually lead to death if not treated.  


==Causes==
==Causes==
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==Differentiating Appendicitis from other Diseases==
==Differentiating Appendicitis from other Diseases==
Appendicitis presents with pain near the [[navel]], specifically the [[right lower quadrant]] of the abdomen.  Because it is mainly characterized by different variants in type of [[abdominal pain]], appendicitis must be differentiated from other diseases and disorders causing similar symptoms.
Appendicitis presents with pain near the [[navel]], specifically the [[right lower quadrant]] of the abdomen.  Because it is mainly characterized by different variants in type of [[abdominal pain]], appendicitis must be differentiated from other diseases and disorders causing similar symptoms. Appendicitis should further be differentiated depending on the patient's age group.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
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==Risk Factors==
==Risk Factors==
Anyone can get appendicitis, but it is more common among people 10 to 30 years old. Appendicitis leads to more emergency abdominal surgeries than any other cause.
Anyone can get appendicitis, but it is more common among people 10 to 30 years old. Appendicitis leads to more emergency abdominal surgeries than any other cause.
==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
If left untreated, appendicitis can lead to death if [[peritonitis]] develops from the rupturing of the [[appendix]].  Acute appendicitis that is evaluated and treated early with an [[appendectomy]] generally leads to no further complications and to a full recovery of the patient.
If left untreated, appendicitis can lead to death if [[peritonitis]] develops from the rupturing of the [[appendix]].  Acute appendicitis that is evaluated and treated early with an [[appendectomy]] generally leads to no further complications and to a full recovery of the patient.
==Diagnosis==
==Diagnosis==
===History and Symptoms===
===History and Symptoms===
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===CT===
===CT===
[[CT scan]]s are the diagnostic test of choice for detecting [[appendicitis]].  They can provide critical information regarding the size of the [[appendix]]. CT scans are preferred over [[ultrasound]]s for the detection of appendicitis.
[[CT scan]]s are the diagnostic test of choice for detecting [[appendicitis]].  They can provide critical information regarding the size of the [[appendix]]. CT scans are preferred over [[ultrasound]]s for the detection of appendicitis.
===MRI===
[[Magnetic resonance imaging]] (MRI) has become the common technique for diagnosing appendicitis in children and pregnant patients.
===Ultrasound===
===Ultrasound===
[[Ultrasound]]s are a useful tool for diagnosing [[appendicitis]].  There are some limitations to the information provided by ultrasounds, such as sometimes ultrasonographic images of the [[iliac fossa]] show no abnormalities despite the presence of appendicitis.  Whenever available, [[CT scan]]s are preferred over ultrasounds for diagnosing appendicitis.
[[Ultrasound]]s are a useful tool for diagnosing [[appendicitis]].  There are some limitations to the information provided by ultrasounds, such as sometimes ultrasonographic images of the [[iliac fossa]] show no abnormalities despite the presence of appendicitis.   
===Other Imaging Findings===
Tc-99m labeled anti-CD15 antibodies can be used in nuclear imaging to confirm appendicitis.
 
==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
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===Surgery===
===Surgery===
Surgery is the most effective therapy in treating [[appendicitis]]. [[Appendicectomy]], or [[laproscopic surgery|laproscopic]] removal of the appendix are the most effective therapies in treating [[appendicitis]]. [[Laproscopic surgery]] is the preferred method of surgery due to reduced complications and recovery time for the patient.
Surgery is the most effective therapy in treating [[appendicitis]]. [[Appendicectomy]], or [[laproscopic surgery|laproscopic]] removal of the appendix are the most effective therapies in treating [[appendicitis]]. [[Laproscopic surgery]] is the preferred method of surgery due to reduced complications and recovery time for the patient.
===Prevention===
===Cost-effectiveness of therapy===
In cases of [[abdominal pain]] suspected to be appendicitis, imaging diagnostic methods are more cost-effective than [[physical exams]] to make accurate diagnostic decisions.
==References==
==References==
{{reflist|2}}
{{Reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Primary care]]
 
[[Category:emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Inflammations]]
[[Category:Surgery]]
[[Category:Medical emergencies]]
[[Category:General surgery]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Disease]]
[[Category:Needs overview]]

Latest revision as of 20:27, 29 July 2020

https://https://www.youtube.com/watch?v=r9amif1DQMc%7C350}}

Appendicitis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Appendicitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Diagnostic Scoring

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

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Risk calculators and risk factors for Appendicitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Appendicitis is a condition characterized by inflammation of the appendix and is the most common abdominal surgical emergency. Symptoms of appendicitis include a brief history of nausea, anorexia, and generalized abdominal pain with an eventual migration of the pain to the right lower quadrant. Fever (higher than 37.3°C) is more often present in infants and young children. CT is considered the diagnostic imaging test of choice for suspected appendicitis. Perforation of an inflamed appendix is seen in 15% to 25% of all patients treated surgically, with the highest rates seen in young children and elderly patients. Treatment of appendicitis depends on whether the patient presents with simple inflammation of an intact appendix or with a perforated appendix with or without abscess. Definitive treatment for patients with appendicitis is an appendectomy. Nonoperative treatment with antibiotics and expectant observation is an option for pediatric patients. If left untreated, mortality is high mainly due to peritonitis and shock.

Historical Perspective

Appendicitis was first officially described by Reginald J. Fitz of Harvard University in 1886. Since that time, the appendectomy has become one of the most common surgical procedures. The laparoscopic appendectomy was invented in 1980, and has led to reduced length of hospital stay, a decreased risk of infection, and a reduction in post-operative pain.

Classification

Appendicitis may be classified at two levels. As appendicitis often results from appendiceal obstruction leading to necrosis and infection, it may be categorized based on the cause of the obstruction or on whether it is perforating or non-perforating.

Pathophysiology

Appendicitis is caused by the obstruction of the tubular space inside the appendix. This initial problem is compounded into a cascade of events that lead to the inflammation of the appendix, the obstruction of the blood vessels supplying it, and infection. Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components. The appendix will rupture and can eventually lead to death if not treated.

Causes

Appendicitis is mainly caused by the retention and obstruction of fecal matter, parasitic or bacterial infections of the appendix, and by physical damage to the appendix.

Differentiating Appendicitis from other Diseases

Appendicitis presents with pain near the navel, specifically the right lower quadrant of the abdomen. Because it is mainly characterized by different variants in type of abdominal pain, appendicitis must be differentiated from other diseases and disorders causing similar symptoms. Appendicitis should further be differentiated depending on the patient's age group.

Epidemiology and Demographics

Appendicitis is a common disease in both Europe and America with about 100 people per 100,000 per year developing cases of appendicitis. Younger people, in the age group of 10-19, have the highest rates of developing appendicitis. Males are more likely than females to develop appendicitis. Whites are more likely than nonwhites to develop appendicitis.

Risk Factors

Anyone can get appendicitis, but it is more common among people 10 to 30 years old. Appendicitis leads to more emergency abdominal surgeries than any other cause.

Natural History, Complications and Prognosis

If left untreated, appendicitis can lead to death if peritonitis develops from the rupturing of the appendix. Acute appendicitis that is evaluated and treated early with an appendectomy generally leads to no further complications and to a full recovery of the patient.

Diagnosis

History and Symptoms

Patients with appendicitis commonly present with pain near the navel that eventually localizes to the right iliac fossa, loss of appetite, fever, nausea, and vomiting.

Physical Examination

Physical examination will mostly be focused on abdominal findings. The patient may be ill appearing, in pain, with a fever and mild tachycardia. Even minimal pressure on the abdomen may elicit a marked response from the patient due to pain.

Laboratory Findings

Common electrolyte and biomarker indicators of appendicitis include leukocytosis, and a shift to the left in the segmented neutrophils.

Diagnostic Scoring

The Alvarado score is the most widely used scoring based system in making a diagnosis of appendicitis.

CT

CT scans are the diagnostic test of choice for detecting appendicitis. They can provide critical information regarding the size of the appendix. CT scans are preferred over ultrasounds for the detection of appendicitis.

MRI

Magnetic resonance imaging (MRI) has become the common technique for diagnosing appendicitis in children and pregnant patients.

Ultrasound

Ultrasounds are a useful tool for diagnosing appendicitis. There are some limitations to the information provided by ultrasounds, such as sometimes ultrasonographic images of the iliac fossa show no abnormalities despite the presence of appendicitis.

Other Imaging Findings

Tc-99m labeled anti-CD15 antibodies can be used in nuclear imaging to confirm appendicitis.

Treatment

Medical Therapy

In combination with surgery, antibiotics given intravenously such as cefuroxime and metronidazole may be administered early to help kill bacteria and thus reduce the spread of infection in the abdomen and postoperative complications in the abdomen or wound. Equivocal cases may become more difficult to assess with antibiotic treatment and benefit from serial examinations. Nonsurgical treatment may be used if surgery is not available, if a person is not well enough to undergo surgery, or if the diagnosis is unclear. Some research suggests that appendicitis can get better without surgery. Nonsurgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides. A soft diet is low in fiber and easily breaks down in the gastrointestinal tract.

Surgery

Surgery is the most effective therapy in treating appendicitis. Appendicectomy, or laproscopic removal of the appendix are the most effective therapies in treating appendicitis. Laproscopic surgery is the preferred method of surgery due to reduced complications and recovery time for the patient.

Prevention

Cost-effectiveness of therapy

In cases of abdominal pain suspected to be appendicitis, imaging diagnostic methods are more cost-effective than physical exams to make accurate diagnostic decisions.

References

Template:WH Template:WS