ACUTE APPENDICITIS (Pt2)

Dr. Richard Boakye- Yiadom

Diagnosis

-Clinical evaluation
-Abdominal CT if necessary
-Ultrasound an option to CT
- X-ray-CBC- Increase of leukocytes
-Urine Test-usually normal but may show small amount of RBC in urine if the appendix is rubbing on the bladder causing irritation.This is to rule out any UTI’s

Alvarado score

A number of clinical and laboratory based scoring systems have been devised to assist diagnosis. The most widely used is Alvarado score.

Symptoms
Migratory right lliac fossa pain	1 point
Anorexia	1 point
Nausea and vomiting	1 point
Signs
Right lliac fossa tenderness	2 points
Rebound tenderness	1 point
Fever	1 point
Laboratory
Leukocytosis	2 points
Shift to left (segmented neutrophils)	1 point
Total score	10 points

A score below 5 is strongly against a diagnosis of appendicitis,while a score of 7 or more is strongly predictive of acute appendicitis. In patients with an equivocal score of 5-6, CT scan is used to further reduce the rate of negative appendectomy.

Differential diagnosis

In children

Gastroenteritis, mesenteric adenitis, Meckel's diverticulitis, intussusception, Henoch-Schönlein purpura, lobar pneumonia, urinary tract infection(abdominal pain in the absence of other symptoms can occur in children with UTI), new-onset Crohn's disease or ulcerative colitis, pancreatitis, and abdominal trauma from child abuse ,distal intestinal obstruction syndrome in children with cystic fibrosis; typhlitis in children with leukemia;

In girls

menarche, dysmenorrhea, severe menstrual cramps, Mittelschmerz, pelvic inflammatory disease, ectopic pregnancy,ovarian cyst

In adults

regional enteritis, renal colic, perforated peptic ulcer, pancreatitis, rectus sheath hematoma; in men: testicular torsion, new-onset Crohn's disease or ulcerative colitis; in women: pelvic inflammatory disease, ectopic pregnancy, endometriosis, torsion/rupture of ovarian cyst, Mittelschmerz (the passing of an egg in the ovaries approximately two weeks before an expected menstruation cycle)  

In elderly

diverticulitis, intestinal obstruction, colonic carcinoma, mesenteric ischemia, leaking aortic aneurysm.

COMPLICATIONS


-pneumonia
-hernia of the incision
- thrombophlebitis
-bleeding or adhesions
-The most serious complication of appendicitis is rupture of the appendix which can lead to peritonitis and abscess formation.
-sepsis formation
- In a few patients, complications of appendicitis is perforation into other nearby organs leading to organ failure and death.

Treatment

-Surgical removal-Appendectomy
-IV fluids and antibiotics 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.
-pain management with morphine or analgesics

for more info contact Doc at orichie10by36@yahoo.com