Appendicitis

Overview

• Definition: Inflammation of the appendix.
• Common Symptoms: Right lower abdominal pain, nausea, vomiting, fever, decreased appetite.
• Severe Complications: Ruptured appendix leading to painful abdominal wall inflammation and sepsis.

Epidemiology

• Frequency: 11.6 million cases globally in 2015.
• Deaths: Approximately 50,100 in 2015.
• Demographics: Most common in ages 5 to 40.

Causes

• Primary Cause: Blockage of the appendix, often due to a faecolith.
• Other Factors: Inflamed lymphoid tissue (viral infection), intestinal parasites, gallstones, tumors.

Diagnosis

• Methods: Symptoms, medical imaging, blood tests.
• Common Imaging Tests: Ultrasound (preferred in children and pregnant women), CT scan (more accurate).
• Signs: McBurney's point tenderness, Blumberg's sign, silent appendix (retrocecal appendicitis).

Pathophysiology

• Process: Blockage leads to increased pressure and bacterial growth.
• Outcome: Inflammation, tissue injury, potential rupture.

Treatment

• Standard Treatment: Surgical removal (appendectomy).
  • Methods: Open surgery (laparotomy), minimally invasive laparoscopic surgery.
• Antibiotics: Sometimes effective for non-ruptured appendicitis.

Signs and Symptoms

• Classic Symptoms: Migratory pain from umbilicus to right lower quadrant, nausea, vomiting.
• Atypical Presentation: May present differently or lack typical progression.

Imaging and Laboratory Tests

• Ultrasound: Detects appendicitis without radiation risk in children.
• CT Scan: Preferred in adults, more accurate.
• MRI: Used in pregnant patients due to lack of radiation.

Differential Diagnosis

• Children: Gastroenteritis, mesenteric adenitis.
• Women: Ectopic pregnancy, pelvic inflammatory disease.
• Men: Testicular torsion.
• Adults/Elderly: Cholecystitis, diverticulitis, colonic carcinoma.

Surgery

• Open Appendectomy: Traditional surgery with a larger incision.
• Laparoscopic Appendectomy: Minimally invasive, faster recovery.

Complications

• Pre-surgery: Nausea, vomiting, need for antibiotics.
• Post-surgery: Hospital stay varies; faster recovery if no rupture.

Prognosis

• Recovery: Quick recovery if treated early.
• Delayed Treatment: Risk of peritonitis and complications if not managed promptly.

History

• Clinical Understanding: Emerged in the 19th century.
• Term "Appendicitis": Coined in 1886 by Reginald Heber Fitz.

Summary

Appendicitis is a common and serious condition that requires prompt diagnosis and treatment to avoid complications like rupture and sepsis. Surgical removal of the appendix is the mainstay of treatment, with antibiotics as an alternative in certain non-complicated cases.