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ACUTE APPENDICSITIS

Predisposing factor : - low fibers diet


Causative factor : - obstruction
- infection
Obstructive agents : - in the lumen of the appendix:
- fecalith
- corpus aleinum
- parasite
Infective agents : - intra lumenar origin
- haematogenous origin
Pathology
Obstruction of the lumen
Mucous retention
Distension (increase intraluminar pressure)
Lymph and venous occlusion
Mucosal and sub mucosal oedema
Bacterial translokation
Inflammation / suppuration
Pus enter the lumen
Over distension
Arteriak occlusion
Pressure necrosis / gangrene

perforation
Progression of disease
- gangrenous
- perforation : - general peritonitis
- peri appendicular mass :
- phlegmoon / infiltrate
- absces
- sepsis
Symtoms
- abdominal pain : - visceral
- somatic
- anorectia, Nausea, Vomiting
- obstipation
- Others : - dysuria
- leucorrhoea
Signs
- Tenderness on the rigth iliac fossa
(specifically on Mc Bourney point)
- Rebound tenderness
- Muscular guarding (locally)
- Rectal examination : pain in the right
- sometimes :- right rectal rigidity
- hypersensitive on the sherens
triangle
Special Test
- Rovsings sign
- Psoass sign
- Obsturators sign
- Tern Horn sign

Laboratory finding
- Leucocytosis (more than 10 000/cmm
- Diff. Tell : shift to the left (neutrofilia)
Differential Diagnosis
1. G.I Tract.
- mesenteric lymphadenitis
- peptic ulcer perforation
- acute cholecystitis
- diverticulitis : - jejunal
- ileal (Meckel)
- colonic
- ileitis terminalis
- tumor of the cecum
2. Urinary tract.
- rigth ureteric colic
- urinary tract infection
3. Gynaecologic disease.
- ruptured ectopic pregnancy
- twisted / torsion ovarian cyste
- ruptured ovarian cyste
- adnexitis
4. Non specific abdominal pain
Treatment
Acute appendicsitis : appendectomy
Negative pathology : 15 20 %
perappendicular mass : - conservative treatment :
- bed rest (fowler position)
- liquid diet
- antibiotic
if resolution : appendectomy a froid
if deteriorate : laparatomy & appendectomy
Radical treatment : laparatomy & appendectomy
General peritonitis : laparatomy & appendectomy
Antibiotic : for gram positive , gram negative
and anaerobe microganisme
Regimen : - ampicilin, gentamycin and
metronidazol
- seftriaxon and metronidazol
CHRONIC APPENDICITIS

- Chronic abdominal pain in the rigth iliac


fossa, but not severe
- Continue or intermittent
- sometimes gastritis like symptoms
- The lumen of the appendix not totally
obstructed
- Appendicogram : - non filling
- partial filling
- filling defect