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Acute Appendicitis
Acute Appendicitis
EPIDEMIOLOGY.
Appendicitis is rare if diets are high in fiber. However, no causal relationship has been
established between dietary fiber and appendicitis.
ETIOLOGY.
PATHOLOGY.
fecal contamination may be confined to the pelvis or the right iliac fossa by the omentum
and adjacent loops of small bowel, or it may spread throughout the peritoneal cavity.
Young children have a poorly developed omentum, and local perforation is not usually
confined. Bacterial invasion of the mesenteric veins may result in portal vein sepsis
(pylephlebitis) and subsequent liver abscess formation. The inflammatory process
associated with perforation may lead to intestinal obstruction or paralytic ileus.
CLINICAL MANIFESTATIONS.
The progression from onset of symptoms to perforation usually occurs over 36–48 hr
Physical Examination.
DD - viral gastroenteritis,
constipation,
urinary tract infection,
hemolytic-uremic syndrome,
Henoch-Schönlein purpura,
mesenteric adenitis
tubo-ovarian disease.
Physical examination
inspection of
the child's behavior
the appearance of the abdomen.
The child with appendicitis frequently moves slowly, hunched forward, and often with a
slight limp.
The child may protect the right lower quadrant with a hand and may be reluctant to climb
onto the examining table.
Auscultation may reveal normal or hyperactive bowel sounds in early then - hypoactive
bowel sounds as it progresses to perforation.
Palpation -be gentle
The right lower quadrant (McBurney point) should be palpated last,
McBurney point is the junction of the lateral and middle thirds of the line joining the
right anterior superior ileac spine and the umbilicus.
The most important physical finding in appendicitis is persistent direct tenderness to
palpation and rigidity of the overlying rectus muscle
Gentle finger percussion in all four quadrants
rectal examination should be the final
- if the diagnosis is in doubt, particularly in the very young (younger than 4 yr) or in the
female adolescent, rectal examination often yields important information.
Examine - ears, mucous membranes, lungs, and skin, for signs of other diseases - identify
shock from sepsis, dehydration
Laboratory Findings.
The presence of bacteria or pyuria greater than 30 white cells per high-power field
suggests true urinary tract infection.
the presence of significant proteinuria or cast formation argues against appendicitis.
Imaging Studies.
plain radiographs of the abdomen or chest,
ultrasonogram,
CT
- - calcified appendicolith, small bowel distention or obstruction, and soft tissue mass
effect.
lower lobe pneumonia
ultrasonography -in adolescent girls, to rule out
pelvic inflammatory disease
ovarian cysts
torsion.
CT of the abdomen has been used for - perforation with multiple intra-abdominal
abscesses. - localization, and percutaneous drainage of abscesses
Barium enema findings are - - mass effect on the cecum
DIFFERENTIAL DIAGNOSIS.
TREATMENT.
COMPLICATIONS.
perforation.
Mortality from appendicitis is low (0.5–1%).
Wound infection
Intra-abdominal abscess
Multiple intra-abdominal abscesses are best treated by open laparotomy with drainage.
Liver abscess from portal vein sepsis
Intestinal obstruction
Infertility caused by adhesions or obstruction of the distal fallopian tube - likely after
perforation.