Appendicitis is an acute inflammation of the appendix, which is a small, tube-shaped sac attached to the caecum.
Causes
- Obstruction: The most common cause is obstruction of the appendix, which can be due to fecaliths (hardened stool), lymphoid hyperplasia, foreign bodies, or tumors.
- Infections: Bacterial or viral infections in the gastrointestinal tract can lead to lymphoid swelling, which may obstruct the appendix.
Diagnosis
- History
- Symptoms: The classic symptom is abdominal pain. Initially, it may be diffuse or peri-umbilical, later localizing to the right lower quadrant (McBurney’s point).
- Nausea and vomiting: Often follow the onset of pain.
- Anorexia: Loss of appetite is common.
- Other symptoms: May include low-grade fever, constipation, or diarrhea.
- Physical Examination
- Tenderness: Focused on the right lower quadrant.
- Rebound tenderness: Pain on the release of pressure is a sign of peritoneal irritation.
- Rovsing’s sign: Pain in the right lower quadrant upon palpation of the left lower quadrant.
- Psoas sign: Pain on extension of the right hip, indicating retrocecal appendicitis.
- Obturator sign: Pain on internal rotation of the flexed right hip, indicating pelvic appendicitis.
- Investigations
- Laboratory tests: Elevated white blood cell count, neutrophilia, CRP
- Ultrasound: Useful, especially in children and pregnant women.
- CT scan: More accurate, particularly in adults, for confirming diagnosis and ruling out other causes.
Differential Diagnosis (DDx)
- Mesenteric adenitis
- Gastroenteritis
- Meckel’s diverticulitis
- Ectopic pregnancy (in women of childbearing age)
- Pelvic inflammatory disease
- Urinary tract infection or kidney stone
- Crohn’s disease
Management
- Antibiotics: Preoperative and sometimes postoperative antibiotics are indicated to prevent or treat infection.
- Referral: Urgent referral to a surgical team is necessary for suspected appendicitis, given the risk of complications like perforation and peritonitis.
- Surgical: The primary treatment for uncomplicated appendicitis is appendectomy, which can be done laparoscopically or through an open procedure.
- Supportive care: Includes hydration, pain management, and nutritional support.
- Non-operative management: In selected cases, particularly with early, uncomplicated appendicitis, antibiotics alone can be considered.
Monitoring and Follow-up
- Post-surgery: Regular monitoring for signs of infection, bowel obstruction, or other complications.
- Antibiotic therapy: If non-operative management is chosen, close follow-up is essential to ensure resolution and monitor for complications.
It’s important to note that early diagnosis and treatment are crucial to prevent complications such as appendiceal rupture, which can lead to peritonitis and sepsis.