Lecture 3

Appendecitis
Professor Zurab Chkhaidze
 Anatomy of the ileocecal area
• The ileocecal area is a short segment of the gastrointestinal tract.
• Components of the ileocecal area are:
- cecum
- appendix
- ileocecal valve
- terminal ileum
• The ileocecal area may be affected by many pathologic conditions including:
appendicitis, diverticulitis, Crohn disease...
 Acute appendicitis
• The appendix is a narrow tube that attaches to the large intestine. It is
located in the lower right side of the abdomen.
• Acute appendicitis is the sudden and severe inflammation of the appendix
 Classification of acute appendecitis
• Normal appendix (type 0)
• Nonvisualized appendix (type X)
• Uncomplicated acute appendicitis (type 1)
• Complicated acute appendicitis without perforation(type 2)
• Complicated acute appendicitis with perforation (type 3)
 Causes of acute appendicitis
• The cause of acute appendicitis is an obstruction of the lumen of the appendix.
This could be due to:
- a viral, bacterial, or parasitic infection in the digestive tract, which can enlarge the
tissue of the appendix wall
- stools causing a blockage in the tube between the large intestine and the appendix
- tumors
- inflammatory bowel disease
- injury or trauma to the abdomen
• When the appendix lumen gets obstructed, bacteria build up in the appendix and
cause acute inflammation with perforation and abscess formation
 Symptoms of acute appendicitis
• Initial periumbilical abdominal pain that then localizes to the right lower quadrant. The
pain may worsen over time or with movement, coughing, sneezing, or touching the
abdomen
• Swollen abdomen
• Nausea and vomiting
• Loss of appetite
• Fever and chills
• Constipation or diarrhea
• Difficulty passing gas
 Diagnosis of acute appendicitis
• Medical history
• Physical examination: rebound tenderness, pain on percussion, rigidity, and guarding
• Blood test to check for a high white blood cell count, which can signal infection
• Urine test to check for urinary tract infections
• Abdominal ultrasound
• CT scan
• MRI scan
 Differential diagnosis
• Abdominal abscess • Ovarian cysts
• Bacterial gastroenteritis • Ovarian torsion
• Crohn disease • Testicular torsion
• Diverticulitis • Urinary tract infection in males
• Cystitis in females
• Ectopic pregnancy
• Inflammatory bowel disease
 Complications of acute appendicitis
• Appendicular perforation
• Peritonitis
• peri appendicular abscess
• Intra-abdominal abscess
• Intestinal obstruction
 Treatment of acute appendicitis
• Appendectomy is the standard treatment for acute appendicitis
• Appendectomy can be performed as:
- open surgery (laparotomy)
- laparoscopic surgery
• If the appendix has ruptured and infection has spread beyond the appendix
or you have an abscess, open appendectomy should be performed.
 Preoperative prophylaxis
• Preoperative antibiotic prophylaxis is recommended in all patients with acute
appendicitis.
• The most popular prophylactic regimen is oral neomycin/erythromycin
along with a short course of a systemic cephalosporin active against
anaerobes.
• The use of postoperative antibiotics is only recommended in cases of
perforation for a minimum period of 3-5 days intravenously.
 Postoperative complications
• Bleeding
• Wound infection
• Inflammation of the belly that can occur if the appendix bursts during
surgery (peritonitis)
• Adhesive intestinal obstruction
• Injury to nearby organs
 Chronic appendicitis
• Chronic appendicitis is long-lasting inflammation of the appendix.
• People with chronic appendicitis have appendicitis that lasts for long periods
of time. If chronic appendicitis is not diagnosed, the person can continue to
experience symptoms for years.
• Chronic appendicitis may occur when the appendix lumen is only partially
blocked. However, the blockage can worsen over time by causing pressure to
build. When pressure overcomes the partial obstruction, the symptoms will
disappear or reduce in intensity.
 Appendicitis in pregnancy
• Appendicitis in pregnant women is very difficult to diagnose due to
unspecific symptoms associated with pregnancy such as abdominal pain,
nausea, and vomiting.
• As a consequence of the diagnostic difficulties, there is increased risk of
serious complications and morbidity.
• If appendicitis is not treated promptly, it might lead to ruptured appendix
and peritonitis. These complications increase chances of preterm delivery
and fetal loss.
• Emergency appendectomy must be immediately performed.
THANK YOU!