Abstract

Appendicitis was rare in the past and still is in traditional Third World populations. It began to increase a century ago, peaked about 1950, and has now fallen to about half its previous incidence. As to causation, dietetically, it was contended that the increase was promoted primarily by an associated fall in dietary fiber intake. The recently advanced hygiene hypothesis considers the increase to have stemmed from improvements in hygiene, generally; these limited exposure to enteric infections and modified response to virus infections, thereby triggering appendicitis. Major uncertainties still prevail over the promotive and precipitating factors of the disease. It is doubtful whether individuals can take any action to avoid appendicitis. A risk factor is anything that increases a persons chance of getting a disease such as Appendicitis. Risk factors for Acute Appendicitis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Acute Appendicitis makes the chances of getting the condition higher but does not always lead to Acute Appendicitis. Age: Appendicitis can occur in all age groups but it is more common between the ages of 11 and 20. Gender: A male preponderance exists, with a male to female ratio (1.4: 1) and the overall lifetime risk is 8.6% for males and 6.7% for females. A male child suffering from cystic fibrosis is at a higher risk for developing appendicitis. Diet: People whose diet is low in fiber and rich in refined carbohydrates have an increased risk of getting appendicitis. Hereditary: A particular position of the appendix, which predisposes it to infection, runs in certain families. Having a family history of appendicitis may increase a child's risk for the illness. Seasonal variation: Most cases of appendicitis occur in the winter months - between the months of October and May. Infections: Gastrointestinal infections such as Amebiasis, Bacterial Gastroenteritis, Mumps, Coxsackievirus B and Adenovirus can predispose an individual to Appendicitis.

http://www.medindia.net/patients/patientinfo/Appendicitis_risk.htm#ixzz1WnhNt03n

The most common symptom of appendicitis is abdominal pain on the right lower side of the abdomen.

Features of abdominal pain The most common early symptom is an aching pain around the navel. The pain often shifts later to the lower right abdomen. As the inflammation in the appendix spreads to nearby tissues, especially the inner lining (peritoneum) of the abdomen, the pain may become sharper and more severe.

Eventually, the pain tends to settle in the lower right abdomen near the appendix known as McBurney point. This point is about halfway between the navel and the top of the right pelvic bone.

Pain will also tend to get worse on coughing, walking or with other jarring movements. The pain may lessen on lying to one side or on pulling up the knees towards the chest. In addition to pain, the patient may have one or more of the following signs and symptoms: Nausea and sometimes vomiting Loss of appetite A low-grade fever that starts after other signs and symptoms appear Constipation An inability to pass gas Diarrhea Abdominal swelling In appendicitis these symptoms tend to become more severe as time passes. Not everyone with appendicitis has all the symptoms. A laxative or enema should not be taken if appendicitis is suspected. Read more: Appendicitis Symptoms | Medindia http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm#ixzz1WnhsD PI2 A history of a patient's symptoms is often the key to making an appendicitis diagnosis. When gathering the medical history, the doctor will ask about the nature, timing, location, pattern, and severity of the pain and other possible appendicitis symptoms like nausea, vomiting, fever and constipation. It is Medications Any Allergies Any Use previous of family alcohol, history of medical and conditions any and other surgeries drugs. previous medical conditions and surgeries important to tell your doctor about:

tobacco,

Before the physical examination, a nurse or doctor will usually measure vital signs, which include: Pulse Temperature Blood Breathing pressure rate. rate

The abdomen is next examined to confirm his suspicion. Location of the pain and tenderness is important. Pain is a symptom described by a patient; tenderness is the response to being touched. Certain specific signs will help to diagnose appendicitis. McBurney's sign - deep tenderness at McBurneys point is a sign of acute appendicitis. Rebound tenderness - If gentle pressure is applied at the McBurneys point, it will feel tender. If the pressure is released suddenly appendicitis pain often will feel worse which is due to inflammation of the peritoneum overlying the appendix area. Guarding refers to the tensing of the abdominal muscles in response to touch. This is indicative of diffuse peritonitis caused due to rupture of the inflamed appendix. Rovsing's sign if gentle compression of the corresponding left side of the lower abdomen is done and results in pain on the right side; the patient is said to have a positive Rovsing's sign and may have appendicitis. Other less commonly elicited signs that may indicate appendicitis include: Aaron's sign is the pain felt in the epigastrium upon continuous firm pressure over McBurney's point. It is indicative of chronic appendicitis. Psoas sign - the patient is positioned on his/her left side and the right leg is extended behind the patient and if this results in lower right sided abdominal pain the sign is positive of inflammation of appendix that lies behind the colon. Obturator sign to elicit this sign first the patient lies on his back with the right hip flexed at 90 degrees. The examiner then holds the patient's right ankle in his right hand. With his left hand, the examiner rotates the hip by pulling the right knee to and away from the patient's body. The appendix may come into physical contact with the obturator internus muscle, which will be stretched by this physical examination maneuver. This causes pain and is an evidence in support of an inflamed appendix.

Blumberg's sign here the abdominal wall is compressed slowly and then rapidly released, presence of pain makes the sign positive which is indicative of peritonitis. While the clinical diagnosis of appendicitis may be straightforward in patients with classic signs and symptoms, atypical presentations can result in delays in treatment. Read more: Appendicitis Diagnosis | Medindia http://www.medindia.net/patients/patientinfo/Appendicitis_diagnosis.htm#ixzz1WniM5h pP

Definition Acute inflammation of the vermiform appendix. Incidence Very common. 1 in 400 people per year. 7-8% of people develop appendicitis in their lifetime. Age Frequent in young children and the elderly but peak incidence in second and third decades of life. Sex Slightly more common in males compared to females. Lifetime risk of 8.6% in males and 6.7% in females. Geography No definite geographical variations. Aetiology In most cases it is thought that appendicitis is caused by obstruction of the lumen. This may be secondary to lymphoid hyperplasia, a faecolith, tumour or other foreign body. The appendix is highly populated by lymphoid tissue and the age of highest incidence supports the hypothesis that hyperplasia of this tissue is a trigger for appendicitis. Obstruction of the lumen leads to bacterial overgrowth and mucous secretion leading to distension and increased pressures, gradually rising above lymphatic and then venous pressures culminating in their obstruction also. This perpetuates the oedema and leads to ischaemia and eventually necrosis (gangrene) of the appendiceal wall. Given time, a gangrenous appendix will perforate leading to localised peritonitis or an appendiceal abscess if it has been walled off by the omentum, or generalised peritonitis. Predisposing factors No factors have been clearly identified. Perhaps there is a familial element as well as diets low in fibre and parasitic infections contributing Article Source: http://EzineArticles.com/816725