Appendicitis

Appendicitis, the most common major surgical disease, is an inflammation of the vermiform appendix, a small, fingerlike projection attached to the cecum just below the ileocecal valve. Although the appendix has no known function, it does regularly fill and empty itself of food. Appendicitis occurs when the appendix becomes inflamed from ulceration of the mucosa or obstruction of the lumen.

Appendicitis can occur at any age, and it affects both sexes equally; however, between puberty and age 25, it's more prevalent in men. Since the advent of antibiotics, the incidence and mortality of appendicitis have declined. If untreated, this disease is fatal.

Causes

Appendicitis is one of the most common causes of emergency abdominal surgery in the United States. Appendicitis usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.

Signs and Symptoms

During the initial phase of appendicitis, the patient typically complains of abdominal pain. Pain may be generalized, but within a few hours it becomes localized in the right lower abdomen (McBurney's point). The patient may also report anorexia, nausea, one or two episodes of vomiting, and a low-grade fever. Later signs and symptoms include malaise, constipatiop and, rarely, diarrhea.

Inspection typically shows a patient who walks bent over to reduce right lower quadrant pain. When sleeping or lying in a supine position, he may keep his right knee bent up to decrease pain.

Auscultation usually reveals normal bowel sounds. Initially, palpation and percussion disclose no localized abdominal findings except diffuse tenderness in the midepigastric area and around the umbilicus. Later, palpation may disclose tenderness in the right lower abdominal quadrant that worsens when the patiem is asked to cough or on gentle percussion. Rebound tenderness and spasm of the abdominal muscles are also usually present. There may be pain in the right lower quadrant resulting from palpating the lower lefi quadrant (Rovsing's sign).

If the appendix is positioned retrocecally or in the pelvis, abdominal tenderness may be completely absent; instead, rectal or pelvic examination reveals tenderness in the flank.

Keep in mind that abdominal rigidity and tenderness worsen as the condition progresses. Sudden cessation of abdominal pain signals perforation or infarction.

Diagnostic tests

Moderately elevated white blood cell count, with increased numbers of immature cells, supports the diagnosis.

Imaging studies aren't necessary in patients with a typical presentation of appendicitis.
Assessment Tip Because other disorders can, mimic appendicitis in presentation, diagnosis must rule out illnesses with similar symptoms: bladder infection, gastroenteritis, ileitis, colitis, acute salpingitis. tubo-ovarian abscess, diverticulitis, gastritis, ovarian cyst, pancreatitis, renal colic, and uterine disease.

Treatment

Appendectomy is the only effective treatment. If peritonitis develops, treatment involves GI intubation, parenteral replacement of fluids and electrolytes, and administration of antibiotics.

Prevention

There is no way of predicting when appendicitis will occur. It cannot be prevented.