Appendicitis is the inflammation of the vermiform appendix.

It typically
presents acutely, within 24 hours of onset, but can also present as a more
chronic condition. Classically, appendicitis initially presents with
generalized or periumbilical abdominal pain that later localizes to the
right lower quadrant.
Apendisitis
Epidemiologi

Appendicitis occurs most often between the ages of 5 and 45, with a
mean age of 28. The incidence is approximately 233/100,000 people.
Males have a slightly higher predisposition of developing acute
appendicitis compared to females, with a lifetime incidence of 8.6% and
6.7% for men, and women, respectively. There are approximately
300,000 hospital visits yearly in the United States for appendicitis-
related issues.
Etiologi
The cause of appendicitis is usually an obstruction of the appendiceal
lumen. This can be from an appendicolith (stone of the appendix) or
some other mechanical etiologies. Appendiceal tumors such as carcinoid
tumors, appendiceal adenocarcinoma, intestinal parasites, and
hypertrophied lymphatic tissue are all known causes of appendiceal
obstruction and appendicitis. Often, the exact etiology of acute
appendicitis is unknown.
 Anatomi

 Persarafan parasimpatis > cabang

nervus vagus. Persarafan simpatis
berasal dari nervus torakalis X.
 Arteri apendikularis > arteri tanpa
kolateral.
Klasifikasi
Patofisiologi
Anamnesis
• Typically, appendicitis presents as an initial generalized or periumbilical abdominal pain
that then localizes to the right lower quadrant. Initially, the visceral afferent nerve fibers at
T8 through T10 are stimulated, and this leads to vague centralized pain. As the appendix
becomes more inflamed and the adjacent parietal peritoneum is irritated, the pain
becomes more localized to the right lower quadrant. Pain may or may not be accompanied
by any of the following symptoms:
• Anorexia
• Nausea/vomiting
• Fever (40% of patients)
• Diarrhea
• Generalize malaise
• Urinary frequency or urgency
Pemeriksaan Fisik
• Signs include:
• Right lower quadrant guarding and rebound tenderness over McBurney's point
(1.5 to 2 inches from the anterior superior iliac spine (ASIS) on a straight line
from the ASIS to the umbilicus)
• Rovsing's sign (right lower quadrant pain elicited by palpation of the left lower
quadrant)
• Dunphy's sign (increased abdominal pain with coughing)
• Other associated signs such as the psoas sign (pain on external rotation or
passive extension of the right hip suggesting retrocecal appendicitis) or
obturator sign (pain on internal rotation of the right hip suggesting pelvic
appendicitis) are rare
 Nyeri Rangsangan Peritoneum Tidak
Langsung

Rovsing Sign
Abdomen kiri bawah ditekan > nyeri
pada abdomen kanan bawah.

Blumberg Sign
Nyeri lepas kontralateral. Penekanan
pada abdomen kiri bawah lalu
dilepaskan. (+) nyeri pada abdomen
kanan bawah saat dilepaskan.
 Nyeri Rangsangan Peritoneum Tidak
Langsung

Psoas Sign
Hiperekstensi sendi panggul
kanan atau fleksi aktif sendi
panggul kanan, lalu menahan
paha kanan.
 Nyeri Rangsangan Peritoneum Tidak
Langsung

Obturator Sign
Gerakan fleksi dan endorotasi sendi
panggul pada posisi telentang.
 Pemeriksaan Fisik
Inspeksi
• Pasien berjalan membugkuk sambal memegangi perut sebelah kanan
• Perut tanpak membuncit dan tegang/distended

Palpasi
• Nyeri tekan dan nyeri lepas
• Defans muscular
• Mc Burney Sign Perkusi
• Rovsing Sign • Nyeri Ketok
• Obturator Sign • Hipertimpani
• Psoas Sign
Auskultasi
• Bising usus melemah/menghilang

Rectal Toucher
• Ampula kolaps, nyeri tekan arah jam 09.00-12.00
 Pemeriksaan Penunjang

Laboratorium
Leukositosis terutama pada kasus dengan komplikasi, namnun bisa denganleukosit
normal
Hitung leukosit > shift to the left.
Pemeriksaan CRP  CRP dapat meningkat
Leukosit normal dengan CRP normal mengeksklusi diagnosis apendisitis
Foto Polos Abdomen
USG Abdomen
Dilatasi lumen.
Menyingkirkan diagnosis banding.
CT Scan Abdomen
Apendikografi
Foto Polos
USG
Scoring System
5-6 dianjurkan untuk diobservasi di
rumah sakit
> 6 sebaiknya dilakukan tindakan
bedah
Tatalaksana
Pemeriksaan Lanjutan
Komplikasi
Terima Kasih