ACUTE APPENDICITIS

DR. BOAKYE-YIADOM RICHARD

ACUTE APPENDICITIS(Part one)

Inflammation of the appendix.

ETIOLOGY: obstruction of the appendiceal lumen typically by lymphoid hyperplasia ,faeces ,foreign bodies,seeds of some fruits and vegetables or even worms and bacterial infection.


Prognosis
Without surgery or antibiotics, mortality is > 50%.

With early surgery, the mortality rate is < 1%, and convalescence is normally rapid and complete. With complications (rupture and development of an abscess or peritonitis), the prognosis is worse: Repeat operations and a long convalescence may follow.

SINGS AND SYMPTOMS:

-begins with vague midabdominal discomfort followed by nausea, anorexia, and indigestion. The pain is persistent and continuous but not severe, with occasional mild cramps.

-There may be an episode of vomiting, and within several hours the pain shifts to the right lower quadrant, becoming localized and causing discomfort on moving, walking, or coughing.

-The patient may feel constipated.

-low grade temperature,37.7-38.3^c

-direct and rebound tenderness located at right iliac region

-Shetkin-Bloomberg-intensifying pain produced by slow pressing of abdominal wall by fingers and taking away hand.This is based on irritation of inflamed peritoneum.

-Rovsing sign-pain felt in the right lower quadrant with palpation of the left lower quadrant

-psoas sign-an increase in pain from passive extension of the right hip joint that stretches the iliopsoas muscle

-Obturator sign - pain caused by passive internal rotation of the flexed thigh

-symptom of "sliding" of the Voskresenskiy-during an expiration, by tips of fingers of a right hand do slipping movement downwards of the left hypochondrium to right ileal area and detain here your hand. During this moment the patient feels intensifying pain in the right iliac region

-Razdolskiy-intensifying of pain in right iliac area on carrying out of a percussion of a front abdominal wall on a course of a framework of a colon in a direction "counter-clockwise".
Dunphy's sign- Increased pain in the right lower quadrant with coughing.

Kocher's (Kosher's) sign- From the history of the disease given, the appearance of pain in the epigastric region or around the stomach at the beginning of disease with a subsequent shift to the right iliac region
Sitkovskiy (Rosenstein)'s sign- Increased pain in the right iliac region as patient lies on his/her left side.
Bartomier-Michelson's sign- Increased pain on palpation at the right iliac region as patient lies on his/her left side compared to when patient was on supine position.

Aure-Rozanova's sign- Increased pain on palpation with finger in right Petit triangle (can be a positive Shchetkin-Bloomberg's sign) - typical in retro-cecal position of the appendix. to be continue

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