Acute appendicitis: clinical manifestations, classification, surgical treatment, complications
Explain the clinical manifestations of acute appendicitis
- Abdominal pain: the first symptom, initially localized to the periumbilical region, persistent aggravation, gradually shifts and fixed in the right lower abdomen
- Gastrointestinal symptoms: nausea, vomiting, increased frequency of bowel movements
- Systemic reactions: fever, lack or loss of appetite, oliguria, thirst, toxic symptoms.
- Rebound tenderness, pain on percussion, rigidity, and guarding, McBurney point tenderness: Most specific finding
- RLQ tenderness but nonspecific
- Left lower quadrant (LLQ) tenderness
- Rovsing sign (RLQ pain with palpation of the LLQ): Suggests peritoneal irritation
- Dunphy sign (sharp pain in the RLQ elicited by a voluntary cough): Suggests localized peritonitis
- Psoas sign (RLQ pain with extension of the right hip or with flexion of the right hip against resistance): Suggests that an inflamed appendix is located along the course of the right psoas muscle
- Laboratory tests: WBC is elevated and urine is normal.
- Other checks: X-ray, B-ultrasound
Pathological classification of acute appendicitis
- acute simple appendicitis
- acute purulent appendicitis
- gangrene or perforating appendicitis
- periappendicular abscess
What should be differentiated from acute appendicitis disease?
- Gastric duodenal ulcer perforation
- Right ureteral stones
- Gynecological diseases: ectopic pregnancy, ovarian follicular or Corpus luteum cyst rupture, acute salpingitis and acute pelvic inflammatory disease
- Acute mesenteric lymphadenitis
* Acute salpingitis is infection of the fallopian tubes.
** Ruptured corpus luteal cysts are one of the commonest causes of spontaneous haemoperitoneum in a woman of reproductive age.
Briefly describe the complications after surgical resection of acute appendicitis
- Incision infection
- Peritonitis, abdominal abscess
- Fecal fistula = one between the colon and the external surface of the body, discharging feces.
- Appendiceal stump inflammation = Stump appendicitis refers to inflammation of the residual appendiceal tissue post appendectomy.
- Adhesive intestinal obstruction
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