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Appendicitis epidemiologi
• With more than 250,000 appendectomies performed annually,
appendicitis is the most common abdominal surgical emergency in the
United States. The peak incidence of acute appendicitis is in the second
and third decades of life; it is relatively rare at the extremes of age.
However, perforation is more common in infancy and in the elderly,
during which periods mortality rates are highest. Males and females are
equally affected, except between puberty and age 25, when males
predominate in a 3:2 ratio. The incidence of appendicitis has remained
stable in the United States over the last 30 years, while the incidence of
appendicitis is much lower in underdeveloped countries, especially parts
of Africa, and in lower socioeconomic groups. The mortality rate in the
United States decreased eightfold between 1941 and 1970 but has
remained at <1 per 100,000 since then.
 ETIOLOGY & RISK FACTORS
The organisms most commonly isolated from perforated appendicitis include Escherichia
coli, alpha-hemolytic streptococci, Bacteroides species (e.g., Bacteroides fragilis),
Bilophila wadsworthia, and Peptostreptococcus species

RISK FACTORS Description

DIET Low fiber and high carbohydrates diets can contribute to
the increased incidence of appendicitis, possibly because
high fiber reduces fecal viscosity, and inhibith fecalith
formation.
GENDER Males tend to get it more often than girls, and men with
cystic fibrosis are more to get appendicitis in childhood.
HEREDITARY History of appendicitis in a first-degree relative
associated with a relative risk for developing the disorder
AGE Appendicitis occurs most often between 11 and 20 years
old, however, you can develop it at any age.
INFECTION Mumps, gastroenteritis, amoebas and bacteria are
common causes of infection.
PREVIOUS APPENDIX INJURY Trauma to the area of the abdomen in the recent past is
labeled as a probable factor in developing appendicitis

http://www.newhealthguide.org/What-Causes-Appendicitis.html
 Symptoms

• Clinical presentation of appendicitis in young children is often nonspecific

and atypical when compared to the adult.
 Non-Modifiable Modifiable Factors :
Factors : ACUTE • Lifestyle
• Gender APPENDICITIS • Environment
• Age
Obstruction of appendix lumen by
fecalith, foreign objects, worms,
tumor

Build up of normal mucus secretions

Raised intra-luminal
pressure

Distention of appendix wall Occlusion of Lymphatic

Next slide
Channels
Irritation of the bowel and
parietal peritoneum

S/Sx :
• Pain
• Loss of appetite

http://www.docstoc.com/docs/82579496/Appendicitis---DOC
 Compromised blood supply to appendix

Decreased O2, WBC, & RBC supply to

appendix

Decreased immunity against normal flora

Bacterial infection

↑ WBC & pus formation

Necrosis of appendix

Appendix
perforation/rupture

Release of contents into peritoneum

S/Sx :
COMPLICATION Peritonitis •Fever
•Diarrhea
Abscess
http://www.docstoc.com/docs/82579496/Appendicitis---DOC
 Diagnosis
• Diagnosis in adults:
– WBC count
– CT scans
– Physical exam
• A positive of :
• Rovsing sign (pain in the right lower quadrant when the left lower
quadrant is pressed) is often a sign of appendicitis.
• Psoas sign (abdominal pain that results when the patient flexes
the thigh at the hip), and
• Obturator sign (pain upon flexion and internal rotation of the hip)
• Mcburney and Blumberg sign
 CLINICAL SCORES
• The Alvarado or
MANTRELS score (Migration to
the right iliac fossa, Anorexia,
Nausea/vomiting, Tenderness in the right
iliac fossa, Rebound pain, Elevated
temperature, Leukocytosis, and Shift of
leukocytes to the left)
– Has been adapted for use
in children and named
the Pediatric Appendicitis
Score (PAS). It is used to
determine the likelihood
that a child has
appendicitis
Epidemiologi anak
 POTASSIUM IMBALANCE
Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L
(3.5 mmol/L). Severe hypokalemia is a level of less than 2.5 mEq/L. 
TRANSMEMBRAN K+