Appendicitis overview: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 56: Line 56:
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Needs overview]]

Revision as of 14:50, 7 February 2013

Appendicitis Microchapters

Home

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

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Appendicitis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Appendicitis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Appendicitis

CDC on Appendicitis

Appendicitis in the news

Blogs on Appendicitis

Directions to Hospitals Treating Appendicitis

Risk calculators and risk factors for Appendicitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Appendicitis is a condition characterized by inflammation of the 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. Appendicitis is usually accompanied by abdominal pain, anorexia, fever, and nausea or vomiting

Historical Perspective

Appendicitis was first officially described by Reignald 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.

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.

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 and 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.

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.

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.

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. Whenever available, CT scans are preferred over ultrasounds for diagnosing 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.

References

Template:WH Template:WS