AHMED MEDICAL LECTURES

🌟 Acute Appendicitis

Acute appendicitis is a common surgical emergency that requires prompt diagnosis and treatment. This detailed guide will provide all the essential information on its pathophysiology, presentation, diagnosis, management, and recent updates.

🔍 What is Acute Appendicitis?

Acute appendicitis is the inflammation of the appendix, a small, tube-like structure attached to the large intestine. This condition typically arises due to an obstruction of the appendix's lumen, which can lead to increased pressure, impaired blood flow, and subsequent inflammation.

Pathophysiology

Obstruction: The most common causes include fecaliths (hardened stool), lymphoid hyperplasia (common in children), tumors, or foreign bodies.

Infection: Bacterial overgrowth occurs, leading to inflammation and necrosis.

Complications: If left untreated, the inflammation can lead to perforation, abscess formation, or peritonitis.

Epidemiology

Incidence: Most common in adolescents and young adults (ages 10-30).

Sex: Slight male predominance.

Geography: More prevalent in industrialized countries.

⚠️ Clinical Presentation

1. Symptoms:

Initial Pain: Typically starts as vague peri-umbilical pain, then localizes to the right lower quadrant (RLQ).

Nausea and Vomiting: Often follow the onset of pain.

Anorexia: Patients frequently report loss of appetite.

Diarrhea or Constipation: May occur, but constipation is more common.

2. Signs:

Fever: Low-grade fever may develop.

Rebound Tenderness: Pain upon release of pressure in the abdomen.

Guarding: Involuntary muscle contraction in the abdomen.

👩‍⚕️ Physical Examination Findings

McBurney’s Point: Tenderness at the RLQ, located one-third the distance from the anterior superior iliac spine to the umbilicus.

Rovsing’s Sign: RLQ pain upon palpation of the left abdomen.

Psoas Sign: Pain on extension of the right hip, suggesting retrocecal appendix.

Obturator Sign: Pain on internal rotation of the right hip, indicating a pelvic appendix.

🩺 Diagnosis

1. Laboratory Tests:

Complete Blood Count (CBC): Leukocytosis with a left shift (increased neutrophils).

C-reactive Protein (CRP): Elevated in cases of inflammation.

2. Imaging:

Ultrasound: First-line imaging in children and pregnant women; shows non-compressible, dilated appendix.

CT Scan: Gold standard in adults; can confirm diagnosis by revealing an enlarged appendix with wall thickening and fat stranding.

MRI: Considered in pregnant patients to avoid radiation exposure.

3. Scoring Systems:

Alvarado Score: A clinical scoring system that helps assess the likelihood of appendicitis based on symptoms, signs, and laboratory findings. A score ≥ 7 suggests appendicitis.

💊 Management

1. Preoperative Care:

NPO: Patients should not eat or drink prior to surgery.

IV Fluids: To maintain hydration and electrolyte balance.

Pain Control: Administer IV analgesics for adequate pain relief.

Antibiotics: Initiated preoperatively (e.g., ceftriaxone + metronidazole) to reduce the risk of postoperative infections.

2. Surgical Intervention:

Appendectomy: The standard treatment, usually performed laparoscopically due to reduced morbidity and quicker recovery.

Open Appendectomy: Indicated in complicated cases or if laparoscopic surgery is not feasible.


Complications Management:

Perforation: Requires prompt surgery and may necessitate additional interventions (e.g., drainage of abscess).

Pseudocyst or Abscess: May be managed with antibiotics and percutaneous drainage before definitive surgery.

3. Postoperative Care:

Monitoring: For complications such as infection or bowel obstruction.

Pain Management: Continue IV or oral analgesics as needed.

Early Mobilization: Encouraged to prevent complications such as deep vein thrombosis (DVT).

🔥 Recent Updates and Key Guidelines

Non-operative Management: Recent studies have suggested that antibiotics alone may be effective in select patients with uncomplicated acute appendicitis, particularly in cases where surgery poses a higher risk.

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11.6K viewsOct 30, 2024 at 04:14

🌟 Acute Appendicitis

Acute appendicitis is a common surgical emergency that requires prompt diagnosis and treatment. This detailed guide will provide all the essential information on its pathophysiology, presentation, diagnosis, management, and recent updates.

🔍 What is Acute Appendicitis?

Acute appendicitis is the inflammation of the appendix, a small, tube-like structure attached to the large intestine. This condition typically arises due to an obstruction of the appendix's lumen, which can lead to increased pressure, impaired blood flow, and subsequent inflammation.

Pathophysiology

Obstruction: The most common causes include fecaliths (hardened stool), lymphoid hyperplasia (common in children), tumors, or foreign bodies.

Infection: Bacterial overgrowth occurs, leading to inflammation and necrosis.

Complications: If left untreated, the inflammation can lead to perforation, abscess formation, or peritonitis.

Epidemiology

Incidence: Most common in adolescents and young adults (ages 10-30).

Sex: Slight male predominance.

Geography: More prevalent in industrialized countries.

⚠️ Clinical Presentation

1. Symptoms:

Initial Pain: Typically starts as vague peri-umbilical pain, then localizes to the right lower quadrant (RLQ).

Nausea and Vomiting: Often follow the onset of pain.

Anorexia: Patients frequently report loss of appetite.

Diarrhea or Constipation: May occur, but constipation is more common.

2. Signs:

Fever: Low-grade fever may develop.

Rebound Tenderness: Pain upon release of pressure in the abdomen.

Guarding: Involuntary muscle contraction in the abdomen.

👩‍⚕️ Physical Examination Findings

McBurney’s Point: Tenderness at the RLQ, located one-third the distance from the anterior superior iliac spine to the umbilicus.

Rovsing’s Sign: RLQ pain upon palpation of the left abdomen.

Psoas Sign: Pain on extension of the right hip, suggesting retrocecal appendix.

Obturator Sign: Pain on internal rotation of the right hip, indicating a pelvic appendix.

🩺 Diagnosis

1. Laboratory Tests:

Complete Blood Count (CBC): Leukocytosis with a left shift (increased neutrophils).

C-reactive Protein (CRP): Elevated in cases of inflammation.

2. Imaging:

Ultrasound: First-line imaging in children and pregnant women; shows non-compressible, dilated appendix.

CT Scan: Gold standard in adults; can confirm diagnosis by revealing an enlarged appendix with wall thickening and fat stranding.

MRI: Considered in pregnant patients to avoid radiation exposure.

3. Scoring Systems:

Alvarado Score: A clinical scoring system that helps assess the likelihood of appendicitis based on symptoms, signs, and laboratory findings. A score ≥ 7 suggests appendicitis.

💊 Management

1. Preoperative Care:

NPO: Patients should not eat or drink prior to surgery.

IV Fluids: To maintain hydration and electrolyte balance.

Pain Control: Administer IV analgesics for adequate pain relief.

Antibiotics: Initiated preoperatively (e.g., ceftriaxone + metronidazole) to reduce the risk of postoperative infections.

2. Surgical Intervention:

Appendectomy: The standard treatment, usually performed laparoscopically due to reduced morbidity and quicker recovery.

Open Appendectomy: Indicated in complicated cases or if laparoscopic surgery is not feasible.


Complications Management:

Perforation: Requires prompt surgery and may necessitate additional interventions (e.g., drainage of abscess).

Pseudocyst or Abscess: May be managed with antibiotics and percutaneous drainage before definitive surgery.

3. Postoperative Care:

Monitoring: For complications such as infection or bowel obstruction.

Pain Management: Continue IV or oral analgesics as needed.

Early Mobilization: Encouraged to prevent complications such as deep vein thrombosis (DVT).

🔥 Recent Updates and Key Guidelines

Non-operative Management: Recent studies have suggested that antibiotics alone may be effective in select patients with uncomplicated acute appendicitis, particularly in cases where surgery poses a higher risk.

BY AHMED MEDICAL LECTURES