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Acute appendicitis (Differentials (Intestinal obstruction, Intussusception…
Acute appendicitis
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Investigations
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Urinalysis. If positive for blood, white cells or nitrates consider UTI as differential
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Scoring system
Alvarado (MANTRELS) score. The higher the score out of a possible total of 10, the greater chance of having acute appendicitis
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Humes, DJ & Simpson J., 2006. Acute Appendicitis. BMJ. 333(7567), pp 530-534. [viewed on 6 May 2019]. Available from:10.1136/bmj.38940.664363.AE
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most common between age 10-20 and in males.
appendicitis is thought to be caused by obstruction of the lumen of the appendix:
Obstruction from faecolith, normal stool and lymphoid hyperplasia (secondary to viral infection)
fragments of indigestible food, mucus, parasites or tumour
obstruction on leads to intraluminal pressure, bacterial overgrowth, ischaemia and necrosis and perforation
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Most common - Perforation
appendix mass (omentumadheres to appendix)
appendix abscess
generalised peritonitis
sepsis
in pregnancy- premature labour/miscarriage
Mucosal appendicitis- mildest form results from inflammation and superficial ulceration of the mucosa without involvement of the whole wall of the organ. Seen as early appendicitis.
phlegmonous appendicitis - inflamed appendix with pus or abscess formation. Slow to develop, stage results from mucosal obstruction and bacterial colonisation.
necrotic appendicitis- acute bacteria invasion of the appendix with loss of blood supply, leading to rapid damage of the wall of the appendix and perforation. The most severe form of appendicitis- possible complication of discharge of faeces into the abdominal cavity and rapid death due to sepsis.
Abdominal pain- typically peri-umbilical or epigastric that worsens over 24h the. Migrated to the RIF. Pain worse on movement.
anorexia
nausea
constipation
vomiting (profuse May indicate peritonitis)
facial flushing, low grade fever, dry,
on examination- tender on percussion/guarding in RIF and rebound tenderness
assess for complications- tachycardia and sudden relief from pain may indicate perforation
a palpable mass and pyrexia may indicate appendix abscess