APPENDICITIS
Appendicitis (or
epityphlitis) is a condition characterized by inflammation of the appendix.
While mild cases may resolve without treatment, most require removal of the
inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality
is high, mainly due to peritonitis and shock.Reginald Fitz first described
acute appendicitis in 1886, and it has been recognized as one of the most
common causes of acute abdomen pain worldwide.
Symptoms
Symptoms of acute appendicitis can be classified into two types, typical and
atypical. The typical history includes pain starting centrally (periumbilical)
before localizing to the right iliac fossa (the lower right side of the abdomen);
this is due to the poor localizing (spatial) property of visceral nerves from
the mid-gut, followed by the involvement of somatic nerves (parietal peritoneum)
as the inflammation progresses. The pain is usually associated with loss of
appetite and fever, although the latter isn't a necessary symptom. Nausea
or vomiting may occur. With the typical type, diagnosis is easier to make,
surgery occurs earlier and findings are often less severe.Atypical symptoms
may include pain beginning and staying in the right iliac fossa, diarrhoea
and a more prolonged, smoldering course. If an inflamed appendix lies in contact
with the bladder, there is frequency of micturition. With post-ileal appendix,
marked retching may occur.
Causes
On the basis of experimental evidence, acute appendicitis seems to be the
end result of a primary obstruction of the appendix lumen. Once this obstruction
occurs the appendix subsequently becomes filled with mucus and distends, increasing
intraluminal and intramural pressures, resulting in thrombosis and occlusion
of the small vessels, and stasis of lymphatic flow. As these progress, the
appendix becomes ischemic and then necrotic. Rarely, spontaneous recovery
can occur at this point. As bacteria begin to leak out through the dying walls,
pus forms within and around the appendix (suppuration). The end result of
this cascade is appendiceal rupture causing peritonitis, which may lead to
septicemia and eventually death.
Treatments
The treatment begins by keeping the patient from eating or drinking anything,
even water, in preparation for surgery. An intravenous drip is used to hydrate
the patient. Antibiotics given intravenously such as cefuroxime and metronidazole
may be administered early to help kill bacteria and thus reduce the spread
of infection in the abdomen and postoperative complications in the abdomen
or wound. Equivocal cases may become more difficult to assess with antibiotic
treatment and benefit from serieal examinations. If the stomach is empty (no
food in the past six hours) general anaesthesia is usually used. Otherwise,
spinal anaesthesia may be used.The
surgical procedure for the removal of the appendix is called an appendicectomy
(also known as an appendectomy). Often now the operation can be performed
via a laparoscopic approach, or via three small incisions with a camera to
visualize the area of interest in the abdomen. If the findings reveal suppurative
appendicitis with complications such as rupture, abscess, adhesions, etc.,
conversion to open laparotomy may be necessary. An open laparotomy incision
if required most often centers on the area of maximum tenderess, McBurney's
point, in the right lower quadrant. A transverse or a gridiron diagonal incision
is used most commonly.(1)
source
(1) wikipedia