Redhy Satya Caesarinka

 Appendix is a tubular organ with a length approximately 10 cm and base on the

cecum. The appendix first appears when embryology development of the eighth
week from the tip of the protuberans cecum. At the time of antenatal and postnatal,
the growth of the cecum excess will be the appendix that will move from the
medial to the ileocaecal valve.
 The parasympathetic innervation comes from the branches of n.vagus that follow
superior a.mesenter and a.apendikularis, where are sympathetic innervation is
derived from n.torakalis X. Therefore, visceral pain in appendicitis begins at
around umbilicus.
 Appendix haemorrhage is derived from the a.curricular artery without collateral. If
this artery is blocked, for example because of thrombosis in the infection,
appendix will have a gangrene
 Appendicitis is a condition which is the infection occurs in the worm. In easy cases
it can heal without treatment, but many cases require laparotomy with removal of
the worms infected. If not maintained, the mortality rate is quite high due to
peritonitis and shock when the contents of the infected worms are destroyed
 Acute appendicitis :
 Acute appendicitis focal or segmental is appendicitis that after recovery will arise local
stricture.
 Diffusion of purulenta appendicitis is appendicitis that already piled up pus

 Chronic appendicitis :
 Chronic or partial chronic appendicitis, after recovery will arise local stricture
 Chronic obliteritiva appendicitis is the oblique Appendix, usually found in old age
 Acute appendicitis is a bacterial infection. Various things act as the causes factor.
Appendix lumen obstruction is a factor as a precipitating factor in addition to
lymph node tissue hyperplasia, fecalite, tumor appendices, and worms may also
cause blockades. Other causes which is thought to cause appendicitis is due to
mucosal erosion of the app
 Epidemiological studies show the habits of eating low fiber food and the influence
of constipation on the incidence of appendicitis. Constipation will raise the
intracuccal pressure, resulting in the occurrence of blockade the functional
appendix and increased growth of ordinary colonic bacterial flora. All this will
raise the emergence of acute appendicitis
 Acute appendicitis is usually caused by a blockage of the appendix lumen that can
be caused by fecalite / appendicolite, lymph node hyperplasia, foreign things,
parasite, neoplasm, or stricture due to previous inflammatory fibrosis
 Lumen obstruction that occurs supports the development of bacteria and mucus
secretion, causing lumen distension and increased luminal wall pressure. The
increased pressure will inhibit lymph flow can causing edema, bacterial
diapedesis, and mucosal ulceration. At that time focal acute appendicitis is
marked by periumbilic pain
 continued mucus secretion and increased pressure cause venous obstruction,
increased edema, and inflammatory bacterial growth. inflammation that arises
widespread and about the local peritonium resulting in pain in the lower right area.
this is called acute suppurative appendicitis
 when then the flow of arteries impaired will arise wall infarcts and gangrene. This
stage is called gangrenous appendicitis and when it is brittle and ruptured it is
called perforated appendicitis. although varied, usually perforation occurs at
least 48 hours after onset of symptoms
 appendicitis complaints are started from periumbilal pain and vomiting due to
peritonium visceral stimulation. within 2-12 hours along with peritoneal irritation,
abdominal pain will move to the lower right quadrant that persists and it can
exacerbated by cough or walking. the pain will progressively progress and with
the examination will show a point with maximum pain. Other symptoms that can be
found are anorexia, malaise, not too high fever, constipation, diarrhea, nausea, and
vomiting
 Anamnesis :
 At anamnesis patients will complain of pain or abdominal pain. It occurs because of
hyperperistaltic to overcome obstruction and occurs in the entire gastrointestinal tract, so
visceral pain is felt throughout the abdomen. Vomiting or visceral stimulation due to
activation of n.vagus. Obstipasi because the patient is afraid to push. Heat from acute
infection if complications arise. Another symptom is a fever that is not too high, between
37.5 -38.5 C. But if the temperature is higher, it is suspected to have occurred perforation
 physical examination
 Inspection : the patient walks bowed while holding his stomach is sick, bloated when there is
perforation, and protrusion of the lower right abdomen seen in appendicular abscess
 Palpation : the abdomen usually appears flat or slightly bloated. Palpate the abdominal wall
lightly and carefully with minimal pressure, starting from a place away from the pain site. Local
right abdomen quadrant localization status
 Tenderness (+) Mc. Burney. In palpation the pain point of the lower right quadrant or Mc.Burney point is
indicated and the key to diagnosis.
 Pain release (+) due to peritoneal stimulation. Rebound tenderness is a severe pain in the lower right
abdomen when the pressure is suddenly released after a slow and deep emphasis at Mc.Burney points.
 Physical examenation cont.
 Muscular Defans (+) due to stimulation m. Rectus abdominis. Muscular defense is the
tenderness of the entire abdominal pitch that indicates the presence of peritoneal parietale
stimulation.
 Muscular Defans (+) due to m.Rectus abdominis stimulation. The muscular defense is Rovsing
sign (+). Rovsing sign is an abdominal pain in the lower right quadrant when emphasis is
placed on the lower left abdomen, this is due to the release of pain released by peritoneal
irritation on the opposite side. tenderness throughout the abdominal field suggesting
peritoneal parietale stimulation.
 Psoas sign (+). Psoas sign occurs because of stimulation of psoas muscle by inflammation that
occurs in the appendix.
 Obturator sign (+). Obturator sign is a pain that occurs when the pelvis and knees are flexed
and then rotated inwardly and externally passively, indicating the inflammation of the
appendix lies in the hypogastric region.

 In percussion there will be a knocking pain. Auscultation would have a normal

peristaltic, peristaltic absence of paralytic illegas due to generalized peritonitis due to
perforated appendicitis. Auscultation is of little help in the diagnosis of appendicitis,
but when peritonitis has occurred there is no intestinal peristalsis.
 Score
Migration of pain from the central abdomen to the right iliac fossa 1
Anorexia 1
Nausea and Vomitting 1
Pain in the right iliac fossa 2
Pain off 1
Increased temperature (> 37.5 C) 1
Increase in the number of leukocytes ≥ 10 x 10 9 / L 2
Neutrophilia from ≥ 75% 1
Total 10
 laboratory examination
 Increase in the number of leukocytes (white blood cells). Light leukocytes (10,000-20,000 /
uL) with an increase in the number of neutrophils. High leukocytes (> 20,000 / uL) are
obtained when perforation and gangrene are present.
 Urinalysis is needed to exclude other diseases of urinary tract inflammation.
 In female patients, obstetric and gynecologic examination is necessary to exclude the
diagnosis of inflammatory abnormalities of the ovarian tube / right ovarian cyst or KET
(pregnancy outside the womb)
 Radiological examination
 Appendicogram barium photograph (Appendicogram) can help see the occurrence of
blockage or the presence of dirt (skibala) in the appendix lumen.
 Ultrasound (Ultrasound) and CT scan may help to establish an acute inflammation of the
appendix or other disease in the pelvic area
 Gastroenteritis
 Dengue Fever
 Abnormalities of ovulation
 Pelvic infection
 Pregnancy outside the womb
 Ovarian cyst twisted
 External ovarian endometriosis
 Urolithiasis pielum / ureter right
 Other gastrointestinal diseases
 The best single treatment for an inflamed appendix / acute appendicitis is to
remove the cause (appendectomy surgery).
 Another alternative surgical removal of the appendix is by laparoscopic surgery.
This operation is performed with a camera tube that is inserted into the abdominal
cavity so that it can clearly see and perform appendectomy and also can examine
the organs in the abdomen more complete than the appendix.
 Perforation
 perforation, either in the form of free perforation or perforation on the appendix that has
been thickened so that the mass consisting of a set of appendix, cecum, and the location
of the small intestine
 Wound infection
 Adhesoin
 Intestinal obstruction
 Abdpminal/pelvic abscess
 Complication after surgery
 wound infections, residual abscess, acute intestinal obstruction, paralytic ileus, external
fecal fistula, internal fusion of feces, and bleeding from the mesenterium of the appendix