Sharing Knowledge

“APPENDICITIS
ACUTE”
USUS BUNTU

Oleh : dr. Oktariana Amindyta

 OVERVIEW
1.Anatomi Abdomen dan 5. Signs and Symtomps
Appendix

2. Apendix 6. Pemeriksaan Fisik

3. Etiologi 7.Pemeriksaan Penunjang

4. Pathophysiology 8. Management
 Anatomi Abdomen dan Appendix

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 APPENDIX
• The appendix is a vermiform ("worm-like) extension of the cecum, a section of the large
intestine[1].
• It is 5-15 cm, hollow organ, proximal is narrower than distal.

FUNCTION
• The exact function of the appendix is unknown, however there are 3 main theories[2]:

1. Immune function (contains lymphoid tissue which is involved in the immune response)

2. Vestigial structure (complete or partial loss of function associated with evolutionary

development)
​
3. Maintain normal gut bacteria (Storage for good bacteria to help repopulate the colon
following a pathogenic infection that cleans out the colon - such as pathogens which cause
diarrhea) 

• References 
1. McCance, K.L. & Huether, S.E.. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th Ed). Maryland Heighs, MO:
Mosby Elsevier.
2. Bollinger, R. R., Barbas, A. S., Bush, E. L., Lin, S. S., & Parker, W. (2007). Biofilms in the large bowel suggest an apparent function of the human
vermiform appendix. Journal of theoretical biology, 249(4), 826-831

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 ETIOLOGI

• Common Causes[2]: • Uncommon Causes[2]:

•
1. Fecal impaction and/or a fecalith
• A layered buildup of calcium salts and
fecal debris around a piece of fecal
material within the appendix
• 2. Lymphoid Hyperplasia
• The appendix contains lymphoid
(immune system) tissue that can
become inflamed as a result of infection
or inflammatory bowel disease (IBD)
• 3. Parasites
• Examples: Schistosomes species,
pinworms, Strongyloides stercoralis
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1. Tumour
2. Foreign Material
• A wide variety of foreign objects can
become lodged in the appendix.
Some of these include: shotgun
pellets, intrauterine devices, tongue
studs, and activated charcoal.
Refferences :
2. Bollinger, R. R., Barbas, A. S., Bush, E. L., Lin, S. S., & Parker, W. (2007). Biofilms in the large bowel
suggest an apparent function of the human vermiform appendix. Journal of theoretical biology, 249(4),
826-831
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PATOPHYSIOLOGY

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 SIGNS AND SYMPTOMPS
• Nyeri abdomen
(nyeri tumpul, nyeri periumbilikal tapi
seiring dengan waktu akan berlokasi di
abdomen kanan bawah)

• Anorexia, mual, muntah

(Onset beberapa jam setelah timbulnya
nyeri ).

• Demam
• Diare
• Konstipasi
• Pembesaran abdomen
• Adanya darah dan/ atau
pus di urin 10
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 PHYSICAL EXAMINATION
• Pada umum nya pasien tampat kesakitan, cara berjalan yang
menunduk.
• Pemeriksaan Abdomen :
• Inpeksi : Abdominal swelling
• Palpasi :
2. Rebound tenderness
1. Nyeri titik mc.burney
(Blumberg sign )

4. Psoas and Obturator sign

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 Nyeri Tekan Titik Mc. Burney

Refferences : www.wikipedia.org Refferences : www.wikipedia.org

Pemeriksaan Fisik

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 Rebound Tenderness ( Blumberg Sign )

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 Rovsing’s Sign

Rovsign Sign

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 Psoas dan Obturator Sign

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 PEMERIKSAAN PENUNJANG

• Laboratorium
• Leukositosis
• Peningkatan jumlah neutrofil ( shift to the left )
• Urinalisis ( Untuk membedakan app dengan
pielonefritis )

• Ultrasonography

• Target sign
• Pertambahan ukuran diameter > 8 mm
• Cairan bebas yang mengitari appendix

• Ct-Scan
• MRI

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Alvarado Score

• score < 5 appendicitis unlikely

• Score 5 -6 appendicitis possible
• Score 7-8 appendicitis likely
• Score 9-10 Appendicitis highly likely

• Refference : Alvarado A.A practical score for the early diagnosis

of acute appendicitis.Ann Emerg Med. 1986; 15 -557-564
DIFFERENTIAL DIAGNOSES

• Kehamilan Ektopik terganggu ( wanita, usia muda ) : USG

• pelvic inflammatory disease (PID) (Nyeri dirasakan bilateral, di
abdomen bawah )
• Kista ovarium
• Infeksi saluran kencing.
• Nefrolithiasis
KOMPLIKASI

Appendicitis Infiltrat

Appendicitis Abses

Peritonotis

Septikemia

Gangguan Peristaltik

Ileus

Mesenterial pyema dengan abses

 MANAGEMENT

APPENDECTOMY

Types of appendectomy: 
• Laparoscopic appendectomy[3].
• Open appendectomy[3].
• New emerging technologies: ​single incision laparoscopic
appendectomy and natural orifice transluminal endoscopic surgery
(NOTES)[3].
3. Bhangu, A., Soreide, K., Di Saverio, S., Assarsson, JH., Drake, FT. (2015). Acute appendicitis: modern understanding of pathogenesis,
diagnosis, and management. Lancet, 386: 1278-87

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 1.Preoperative Management 2. Postoperative Management 

2. Keep patients on NPO 1. Administer analgesic and antiemetic if needed for

(withhold from oral foods and fluids)[3]. pain and vomiting[3].
2. Establish IV access and administer parenteral 1.Encourage early ambulation[3].
analgesic[3]. 2.Administer postoperative antibiotics[3].
3. Administer parenteral prophylactic antibiotic[3].
•Not recommended as a routine use
•Start at least 60 minutes prior to appendectomy •Only recommended for complicated perforated
•Significantly reduces wound infection appendicitis: postoperative intravenous antibiotics
•Use antibiotics with broad coverage of gram- for 3 to 5 days. Antibiotic treatment will be stopped
negative and anaerobic bacteria​ when core temperature is <38°C for 24 hours,
                                                                                            patient tolerates two meals consecutively, mobilize
independently, and WBC (white blood cell) count
normalizes.                                     

3. Bhangu, A., Soreide, K., Di Saverio, S., Assarsson, JH., Drake, FT. (2015). Acute appendicitis: modern understanding of pathogenesis,
diagnosis, and management. Lancet, 386: 1278-87

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