Appendicitis

Appendicitis is a condition characterised by inflammation of the appendix.

Causes

\nIt is possible for matter to become lodged in the appendix, leading to bacterial infection, which can cause appendicitis. If the condition is untreated, the appendix can turn gangrenous and can eventually burst, leading to peritonitis, septicemia and eventually death.

Signs, symptoms and examination findings

\nThe pain of appendicitis usually starts centrally (periumbilical) before localising to the right iliac fossa (the lower right side of the abdomen). There is usually associated anorexia (loss of appetite). Fever is usually present. Nausea, vomiting and diarrhea may or may not occur. There is typically pain and tenderness in the right iliac fossa. Rebound tenderness may be present suggesting that there is some element of peritoneal irritation. If the abdomen is guarded, there should be a strong suspicion of peritonitis requiring urgent surgical intervention.

Diagnosis

\nDiagnosis is based on history and physical examination backed by blood tests and other diagnostic procedures. The classical physical finding in appendicitis is diffuse pain in the umbilical region which can become localised at McBurney's point if the imflammed appendix comes into contact with the parietal peritoneum. This point is located on the right-hand side one-third of the distance between the anterior superior iliac spine and the navel, or approximately one hand's width.\nOther methods include a digital rectal exam, where a finger is inserted into the rectum - if there is right sided tenderness (where the appendix normally lies), it makes it more likely that the patient has appendicitis. Other signs used in the diagnosis of appendicitis are the psoas sign (common in retrocecal appendicitis), the obturator (internus) sign, and Rovsing's sign.

Treatment

\nAppendicitis can be treated by removal of the appendix through a surgical procedure called an appendicectomy (also known as an appendectomy). Antibiotics are given intravenously to help kill remaining bacteria and thus reduce the inflammation.

Prognosis

\nMost appendicitis patients recover easily with treatment, but complications can occur if treatment is delayed or if peritonitis occurs secondary to a perforated appendix. The real possibility of life-threatening peritonitis is the reason why acute appendicitis warrants speedy treatment. The patient may have to undergo a medical evacuation. Appendicectomies have occasionally been performed in emergency conditions (i.e. outside of a proper hospital), when a timely medical evacuation was impossible.

See also

\n* Gastroenterology

External links

• The Merck Manual of Diagnosis and Therapy: Appendicitis\n* Stanford Health Library: Appendicitis

Category:medical emergencies \n\n