Acute appendicitis : Expect your diagnosis to be wrong about 50% of the time. This means that those who seen no to have appendicitis should be constantly re-examined.
Symptoms : As the inflammatory process begins the patient feels a colicky pain referred to the central part of the abdomen. Once the peritoneum becomes involved with the inflammatory process the pain shifts to the right iliac fossa and it may be accompanied by diarrhoea and vomiting.
Signs
Fever Lying still RIF signs
Tachycardia Flushed Tenderness,guarding
Furred tongue Coughing hurts Rebound tenderness
Shallow breaths PR painful on right
Special Tests include Rovsigng's sign which is pain more in the RIF than the LIF when the LIF is pressed. Indirect rebound tenderness may also be felt in the RIF after pressure is released in the LIF.
With the obturator test the hip is flexed and internally rotated. If this produces more pain when it is the right hip that is flexed, it is a sign of a deep-lying inflamed appendix irritating the obturator muscle.
Variations in the picture
- The schoolboy with vague abdominal pain who will not eat his favourite food.
- The infant with diarrhoea and vomiting.
- The shocked,confused octogenarian,not in pain.
If the child is anxious, use his hand to press his belly. Do not rely on tests such as WCC or urinoscopy.
Perforated ulcer Cholecystitis Mesenteric adenitis
Food poisoning Diverticulitis Salpingitis
Cystitis Crohn's
Treatment : Early appendicectomy. Metronidazole suppositories 1g/8h, three doses PR starting 1 h pre-operatively, reduces wound infections (eg.,from 24% to 12% in one study).
Perforation leading to peritonitis; formation of an appendix mass (inflamed appendix surrounded by omentum): appendix abscess.
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