Name
APPENDICITIS, CHRONIC
DESCRIPTION
DETAIL
CAUSES: . Obstruction of appendiceal lumen . Fecaliths (most common) . Lymphoid tissue hypertrophy . Inspissated barium . Vegetable, fruit seeds and other foreign bodies . Intestinal worms (ascarids) . Strictures -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Any cause of the acute abdomen β’ 75% of erroneous diagnoses accounted for by acute mesenteric lymphadenitis, no organic pathologic condition, acute PID, twisted ovarian cyst, ruptured graafian follicle, acute gastroenteritis β’ Also consider urologic causes, inflammatory bowel disease, colonic disorders, and other gynecologic diseasesβ’ Moderate leukocytosis - 10,000 to 12,000/mm3 in 25% β’ Moderate polymorphonuclear predominance β’ Urinalysis-elevated specific gravity, hematuria (sometimes), pyuria (sometimes), albuminuria (sometimes IMAGING (Used in differential diagnosis and to detect complications) β’ X-RAY KUB: gas-filled appendix; radiopaque fecalith; deformed cecum; fluid level; ileus; free air β’ Barium enema-non-filling appendix; RLQ mass effect β’ Ultrasound-appendiceal inflammation; other pelvic pathology, such as infl ammatory mass β’ CT scan - diagnostic test of choice; also for abscess β’ Cornerstone of diagnosis is history and clinical findings β’ Diagnostic laparoscopy - consider in young adult females β’ Rectal and pelvic examinations β’ Intensive in-hospital observation
TYPENOTES
GENERAL MEASURES : . Preoperative preparation . Correction of fluid and electrolyte deficits . Consider broad-spectrum antibiotic coverage . For non-surgical patients, antibiotic coverage (e.g. quinolone + metronidazole) SURGICAL MEASURES : . Immediate appendectomy; open or laparoscopic . Drainage of abscess, if present DRUG TREATMENT : β’ Uncomplicated acute appendicitis - one preoperative dose of broad spectrum antibiotic; cefoxitin (Mefoxin), cefotetan (Cefotan) β’ Gangrenous or perforating appendicitis - broadened antibiotic coverage for aerobic and anaerobic enteric pathogens, dosage and choice of antibiotic should be adjusted based on intraoperative cultures. Continue antibiotics for 7 days postop or until patient becomes afebrile with normal white count. Pathogens usually sensitive to ampicillin, gentamicin, and clindamycin POSSIBLE COMPLICATIONS . Wound infection . Intra-abdominal abscess, sometimes diaphragmatic . Fecal fistula . Intestinal obstruction . Incisional hernia . Liver abscess (rare) . Peritonitis with paralytic ileus EXPECTED COURSE/PROGNOSIS . Generally uncomplicated course in young adults with non-ruptured appendicitis. . Factors increasing morbidity and mortality are extremes of age and appendiceal rupture. . Morbidity rates: . 3% with non-perforated appendicitis . 47% with perforated appendicitis . Mortality rates: . 0.1% unruptured acute appendicitis . 3% ruptured acute appendicitis . 15% elderly patient with ruptured appendix
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
TOTAL LEUCOCYTE COUNT, DIFF. LEUCOCYTE COUNT, URINE ROUTINE, X-RAY ABDOMEN A.P. VIEW FOR KUB, ULTRA SOUND WHOLE ABDOMEN - MALE, CT SCAN ABDOMEN