Acute Appendicitis

The most important factors in diagnosing appendicitis are the history and physical examination. Because patients come to the ED at various times within the course of the disease and may have atypical symptoms, a period of observation and reexamination may be necessary.

Causes

The possible causes of Acute Appendicitis are included in the list below:

• Pelvic kidney
• Ovarian cyst
• Appendicitis may occur after a viral infection in the digestive tract or when the tube connecting the large intestine and appendix is blocked by trapped stool.
• Obstruction of the appendiceal lumen usually precipitates appendicitis.
• Appendicitis usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.

Symptoms

• Abdominal pain that begins periumbilically or diffusely and localizes to the right lower quadrant over the next 12 to 48 hours ++++
• Anorexia ++++
• Nausea and vomiting +++
• Diarrhea ++

Signs

• Abdominal tenderness ++++
• Fever +++
• Rebound tenderness +++
• Rovsing sign (peritoneal irritation producing right lower quadrant pain with palpation of the left lower quadrant)
• Psoas sign (pain with active flexion against resistance or passive extension of the right hip) ++
• Obturator sign (pain with passive internal rotation of the
  flexed right hip) ++
• Voluntary or involuntary guarding
• Cervical motion tenderness ++

Treatment

Treatment for patient with suspected acute appendicitis.

• The patients with suspected appendicitis should not receive anything by mouth.
• Consider ectopic pregnancy in women of childbearing age and obtain a qualitative beta–human chorionic gonadotropin in all cases.
• Administer IV antibiotics to those with signs of septicemia and to those who are to proceed to laparotomy.

Treatment of acute appendicitis is appendectomy; the surgeon can usually remove the appendix, even in the presence of some other disease. The appendix is difficult to locate; in these cases, it usually lies behind the cecum. A contraindication to appendectomy is inflammatory bowel disease involving the cecum. However, in cases of terminal ileitis and a normal cecum, the appendix usually is removed.