Understanding Appendicitis: Causes & Treatment
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ScribdTranslationsUnderstanding Appendicitis: Causes & Treatment
Translated by
ScribdTranslationsINTRODUCTION
The present report describes the development of appendicitis. The appendix is a small pouch
that the large intestine stands out. It is said that it may have an immune function, without
however, it is an essential organ for humans. Appendicitis is a
inflammation of the appendix and is one of the most frequent causes of abdominal pain, likewise
like abdominal surgery. This pathology can affect at any age, however,
it is usually more common in the second and third decades of life.
ETIOLOGY
It is believed that appendicitis is due to the obstruction of the appendiceal lumen, generally caused by
lymphoid hyperplasia but, on occasions, due to a fecalith, a foreign body or even helmints.
Obstruction causes distension, bacterial proliferation, ischemia, and inflammation. If not
treated, necrosis, gangrene, and perforation occur. If the perforation is contained by the
epiploon, an appendicular abscess forms.
CLINICAL PICTURE
1.- The classic clinical picture of appendicitis begins with acute abdominal pain, colicky in nature,
located in the periumbilical region, with a rapid increase in intensity, within 24 hours
migrate to the lower right quadrant (RLQ), after the onset of pain there may be nausea and
not very numerous vomiting (generally on 2 occasions). There may be a fever of 38° C or
more. The pain increases when walking and coughing.
2.- The physical examination reveals data of peritoneal irritation (hypersensitivity in
lower right quadrant (LRQ), defense and involuntary muscle rigidity, McBurney point,
signo de Rovsing, signo de Psoas, signo del Obturador, signo de Summer, signo de Von
Blumberg, sign of rebound tenderness, sign of Dunphy.
3.- Of the clinical and laboratory manifestations, those that have the greatest sensitivity for the
The diagnosis of appendicitis (cardinal manifestations) are: a) Characteristic pain (migration)
from the periumbilical region to the right iliac fossa or initial location in the right iliac fossa b) Signs of irritation
peritoneal (hipersensibilidad en CID, rebote positvo en CID, defensa y rigidez de músculos
abdominals) c) Inflammatory response data (leukocytosis with greater predominance of
neutrophils
DIAGNOSIS
To help diagnose appendicitis, the doctor is likely to take note of the
background of your signs and symptoms, and examine your abdomen.
The tests and procedures used to diagnose appendicitis include:
- Physical examination to evaluate pain. The doctor may apply gentle pressure on the
painful area. When the pressure is suddenly released, the pain from appendicitis often
It will worsen, indicating that the adjacent peritoneum is inflamed.
The doctor can also look for abdominal rigidity and a tendency for the muscles to harden.
abdominal response to pressure on the inflamed appendix (protection).
The doctor can use a lubricated glove to examine the lower rectum (rectal examination). To the
women of childbearing age may be advised to have a pelvic exam to detect possible
gynecological problems that could be causing the pain.
Blood test. This allows the doctor to check if there is a high number of blood cells.
whites, which may indicate an infection.
Urine analysis. The doctor may ask you for a urine analysis to ensure that
the cause of the pain is not a urinary tract infection or a kidney stone.
The Alvarado Scale also allows us to diagnose in acute abdomen.
lapendicitsaguda in the high-risk group, patients with scores that include them in the
intermediate risk group, decisions must be cautious when considering the
disease.
IMAGING DIAGNOSTICS
Radiology: chest radiology is essential because it allows us to rule out others
conditions such as cardiopulmonary diseases. Abdominal radiology usually
it can be normal, or there may be dilation of the intestinal loops due to paralysis
from the peristaltic movements. Exceptionally, a small piece of stool may be observed.
calcified in the right iliac fossa.
Ultrasound:es muy útl para el diagnóstco y para descartar otras
diseases. In the case of appendicitis, the ultrasound can see the inflamed appendix or
free fluid in the abdomen. However, sometimes it is not found
no abnormal findings despite the presence of appendicitis.
Computed axial tomographytadorized (TAC)The CT scan is a very reliable diagnostic method.
In the diagnosis of appendicitis, it is increasingly used in cases of doubt. Also
it allows to rule out other pathologies.
Laparoscopyin cases of difficult diagnosis, especially in women of childbearing age,
obese or elderly patients, laparoscopy may be used to confirm the
diagnosis. Currently, excellent results are obtained using the technique of
simple laparoscopic incision (SILS-laparoscopy), through which it is possible to perform not only
an exploration, but also the laparoscopic surgery of the appendix (appendectomy)
laparoscopic).
PHYSICAL EXAMINATION
The general state of the patient is usually good, although in advanced stages of appendicitis.
it usually deteriorates. The temperature is around 37.5 and 38 ºC.
In abdominal exploration, there are signs that can help with the diagnosis:
Pain at McBurney's point: a line is drawn from the navel to the tip
of the right anterior pelvic bone. The point is the junction of the two thirds more
close to the navel with the outer third.
Blumberg's sign: when pressing on an area of the abdomen away from the appendix,
produces pain in this reflective dorma. Indicates peritoneal irritation and occurs in others.
diseases.
Abdominal pain when extending the thigh: this maneuver is only useful when the
the appendix has a retrocecal location, that is, it is placed behind the colon and,
Therefore, abdominal palpation is not that effective.
There is a maneuver that can be done at home to suspect or rule out appendicitis.
It consists of the patient standing on tiptoes and letting themselves fall onto their heels.
sudden onset. In cases of appendicitis, the pain in the lower right region increases. For
Assumption is not a very reliable test, but it can help.
SYMPTOMS
The signs and symptoms of appendicitis may include:
Sudden pain that starts on the right side of the lower abdomen
Sudden pain that starts around the belly button and often moves towards the
lower right part of the abdomen
Pain that worsens when you cough, walk, or perform other sudden movements
Nausea and vomiting
Loss of appetite
Mild fever that can worsen as the disease progresses
Constipation or diarrhea
Abdominal swelling
Flatulence
The place where you feel pain may vary, depending on your age and the position of the appendix.
During pregnancy, the pain would seem to come from the upper part of the abdomen because the
the appendix is located higher during pregnancy.
TREATMENT
The appendectomy can be performed as an open surgery, making an incision in the
abdomen of 2 to 4 inches (5 to 10 cm) long approximately (laparotomy). Or the
surgery can be performed through small incisions in the abdomen (surgery
laparoscopic). During a laparoscopic appendectomy, the surgeon inserts instruments
special surgical instruments and a camera in the abdomen to remove the appendix.
In general, laparoscopic surgery allows you to recover faster and heal with less
pain and scars. It may be better for older adults and people with obesity.
However, laparoscopic surgery is not suitable for everyone. If the appendix has perforated and the
If the infection has spread beyond the appendix or you have an abscess, you may need a
open appendectomy, which allows the surgeon to clean the abdominal cavity.
Keep in mind that you may spend one or two days in the hospital after the
appendectomy.
Drain an abscess before an appendectomy
If the appendix has burst and an abscess has formed around it, the abscess can be drained.
inserting a tube through the skin. Appendectomy can be performed several weeks
after having controlled the infection.
CAUSAS
The probable cause of appendicitis is an obstruction in the lining of the appendix that leads to
as a result an infection. The bacteria multiply rapidly and cause the
the appendix becomes inflamed, swells, and fills with pus. If not treated immediately, the appendix
it can break.
COMPLICATION
Appendicitis can cause serious complications, for example: Appendix perforation.
This can cause the infection to spread through the abdomen (peritonitis). This disease
it can endanger life and it is necessary to perform surgery immediately to remove the
appendix and clean the abdominal cavity.
FINAL CONSIDERATIONS
Acute appendicitis is and will continue to be a challenge even for the most experienced doctor or surgeon.
experienced. One should resort to the methods available today and are at
scope to diagnose it in a timely manner and, if deemed prudent, take the patient to
surgery with curative purposes and avoid the serious complications that currently
let's continue.
CLINICAL CASE: ACUTE APPENDICITIS.
Case description: 12-year-old boy who comes to the emergency room accompanied
for her mother for abdominal pain of colicky type, of mild intensity, located in the epigastrium.
It refers to having approximately 48 hours of pain, nausea, fever, and tachypnea.
Complementary tests: A complete blood count is performed in which some levels
they appear altered. ECDO of the abdomen shows an elongated tubular image, not compressible
with transducer in right iliac fossa.
Diagnosis: Acute appendicitis.
Evolution: An urgent appendectomy is performed in which the
subcecal appendix. Metoclopramide 10 mg/8h, tramadol 100 mg/8h is administered.
Conclusions: Acute appendicitis is an inflammation of the cecal appendix, in these cases its
treatment is a surgical intervention.