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Appendix

The document outlines the clinical features, causes, and treatment of acute appendicitis, highlighting the differences between obstructed and non-obstructed appendices. It details symptoms such as pain, anorexia, and special signs like Rovsing's and Psoas signs, along with diagnostic investigations like WBC count. Treatment options include appendectomy for acute cases, while appendicular masses and abscesses may require conservative management or drainage.

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albtashmoh770
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4 views1 page

Appendix

The document outlines the clinical features, causes, and treatment of acute appendicitis, highlighting the differences between obstructed and non-obstructed appendices. It details symptoms such as pain, anorexia, and special signs like Rovsing's and Psoas signs, along with diagnostic investigations like WBC count. Treatment options include appendectomy for acute cases, while appendicular masses and abscesses may require conservative management or drainage.

Uploaded by

albtashmoh770
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Appendix ‫نعمة عيسى‬

Pathology :
Clinical features :
Bacteria Invade wall
•Obstructed appendix Wall damaged • History / Examination
by pressure necrosis , then arteries will thrombosed ,
gangrene and followed by perforation ! • Special signs / Special investigations

• Non-obstructed appendix : direct infection of lymphoid 1- History :


follicles , its more likely to resolve than obstructed form
Site : starts periumbilical colic then shift to RIF
• Pain :
Movement
Acute appendicitis Resolution Hip and knee flexed

• Anorexia and Nausea , Vomiting .


• Constipation is usual , but diarrhea may occur .
Perforation

2. Examination : Note :
Localized Generalized Patient looks Toxic ! With perforation may
be cessation of pain ,
Pyrexia and Tachycardia
followed by sever
Causes of obstruction : Localized tenderness generalized pain
[Link] 2. Foreign body 3. Fibrous stricture Rebound tenderness
4. Enlarged lymphoid follicles 5. Carcinoid tumor Diffuse tenderness in GP .

Note :
3. Special signs :
In infant : wide mouthed and well drained 1. Rovsing's sign si pain felt ni the right lower quadrant on deep
In old age : almost obliterated palpation of the left lower quadrant.
So at the two extremes of the life is relatively rare .. 2. Psoas sign is pain on extension of the right thigh.
3. Obturator sign is pain on internal rotation of the flexed right

variations of the position of the appendix: thigh .


4. Hyperesthesia in Sherren's triangle Ddx :
1. Pelvic appendix : May induce tenesmus from rectal irritation, and Meckel's diverticulitis
dysuria Acute Crhon's ileitis
4. Special investigations : Acute intestinal obstruction
2. Subhepatic appendix : Pain and tenderness are higher than the
• WBC = leukocytosis Perforated peptic ulcer
McBurney's point. Panceratitis
• Uss = to exclude ddx .
Salpingitis
3. Long retrocecal appendix : Tenderness is felt ni the right loin.
4 . Retro-ileal appendix : Diarrhea may occur when the ileum is
irritated. Treatment : Alvardo Score : > 7 = high
3 symptoms :

• Acute appendicitis = appendectomy RIF pain , Nausea Anorexia

EXCEPT :
-Appendicular mass has formed , it 3 signs :

managed conservatively . Tenderness in RIF , Rebound


pain , high temperature

• appendicular abscess = drainage


• Recurrent subacute appendicitis = 2 investigation :

appendectomy Leukocytosis , WBC shift to lt

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