Appendicitis: Introduction, Pathogenesis, Cllinical features, Lab findings, Imaging, Management 

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Appendicitis: Introduction, Pathogenesis, Cllinical features, Lab findings, Imaging, Management -
---------------------------------------------------------------------------------------------------------------------Introduction :
Appendicitis is an acute inflammation of the vermiform appendix, a narrow, finger-like pouch connected to the cecum, the first part of the large intestine. It is one of the most common causes of abdominal pain requiring emergency surgery. If left untreated, the appendix can rupture, leading to severe complications such as peritonitis or abscess formation.
Pathogenesis :
The exact cause of appendicitis is not fully understood, but the inflammation is typically caused by the Obstruction of the lumen of the appendix, followed by infection.
Common Causes of Obstruction:
-Fecaliths (hard stool pieces)
- Lymphoid hyperplasia (enlargement of lymphoid tissue, common in young adults and children)
- Foreign bodies (rare)
- Tumors (rare cause in older adults)
Pathophysiology:
1. Obstruction leads to increased pressure within the appendix.
2. This results in impaired blood flow and ischemia
3. Bacterial overgrowth follows, leading to infection and Inflammation.
4. Necrosis and gangrene may develop, and if untreated, the appendix can rupture, causing widespread infection in the abdomen (peritonitis).
Clinical Features :
1. Abdominal Pain:
- Initially peri-umbilical (around the belly button) due to referred pain.
- Pain migrates to the right lower quadrant (RLQ) in a few hours, known as McBurney's point tenderness- Pain is worsened by movement, coughing, or sneezing.
2. Fever: Low-grade fever may be present but can increase if the appendix ruptures.
3. Nausea and Vomiting: Often follows the onset of pain, due to irritation of the peritoneum and intestines.
4. Loss of Appetite: Almost universal in patients with appendicitis.
5. Change in Bowel Habits: May include constipation or diarrhea, although less common.
6. Rebound Tenderness: Pain upon release of pressure on the RLQ, a sign of peritoneal irritation.
Other clinical signs include:
- Rovsing’s sign: RLQ pain when pressure is applied to the left lower quadrant.
- Psoas sign: Pain with passive extension of the right thigh, indicating irritation of the psoas muscle.
- Obturator sign: Pain with internal rotation of the right thigh.
Lab Findings:
While laboratory tests alone cannot confirm appendicitis, they can support the diagnosis:
- White Blood Cell Count (WBC): Elevated, typically indicating infection and inflammation.
- C-Reactive Protein (CRP): Increased in cases of acute inflammation.
- Urinalysis: To rule out urinary tract infection (UTI) or kidney stones, which can mimic appendicitis.
Imaging :
Imaging plays a crucial role in confirming the diagnosis of appendicitis, especially in atypical cases.
1.Ultrasound:
- First-line imaging in children and pregnant women.
- Findings:Enlarged, non-compressible appendix(greater than 6mm), free fluid, and sometimes an appendicolith (stone within the appendix).
2. CT Scan (Computed Tomography):
- Gold standard for diagnosing appendicitis in adults.
- Findings: Enlarged appendix, peri-appendiceal fat stranding, wall thickening, and possible rupture with free air or abscess formation.
3. MRI: Occasionally used in pregnant women to avoid radiation exposure from a CT scan.
Management and Treatment :
The *treatment for appendicitis* is almost always **surgical**, though antibiotics can be used in selected cases of uncomplicated appendicitis.
Surgical Options:
1. Appendectomy (Removal of the Appendix):
- Laparoscopic Appendectomy: Minimally invasive, results in shorter hospital stays and faster recovery. Preferred in uncomplicated cases.
- Open Appendectomy: Performed if complications like abscesses or perforation are present. This is also an option in resource-limited settings.
Complications:
1. Perforation: Rupture of the appendix, leading to peritonitis or abscess formation. Requires emergency surgery.
2. Abscess: Localized infection requiring drainage.
3. Sepsis: If the infection spreads to the bloodstream, it can be life-threatening.
4. Bowel Obstruction: May occur post-operatively due to adhesions.
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