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.
  • Signs:
    1. Rebound tenderness, pain on percussion, rigidity, and guarding, McBurney point tenderness: Most specific finding
    2. RLQ tenderness but nonspecific
    3. Left lower quadrant (LLQ) tenderness
    4. Rovsing sign (RLQ pain with palpation of the LLQ): Suggests peritoneal irritation
    5. Dunphy sign (sharp pain in the RLQ elicited by a voluntary cough): Suggests localized peritonitis
    6. 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
  • Bleeding
  • 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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