Appendicitis is a condition characterized by inflammation of the appendix. It is a painful swelling and infection of the appendix.It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy.
Causes
Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of obstruction include
• Feces, parasites, or growths that clog the appendiceal lumen
• Enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
• Trauma to the abdomen
Symptoms
Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain.
The abdominal pain usually
• Occurs suddenly, often causing a person to wake up at night
• Occurs before other symptoms
• Begins near the belly button and then moves lower and to the right
• Is new and unlike any pain felt before
• Gets worse in a matter of hours
• Gets worse when moving around, taking deep breaths, coughing, or sneezing
Other symptoms of appendicitis may include
• Loss of appetite
• Nausea
• Vomiting
• Constipation or diarrhea
• Inability to pass gas
• A low-grade fever that follows other symptoms
• Abdominal swelling
• The feeling that passing stool will relieve discomfort
Symptoms vary and can mimic other sources of abdominal pain, including
• Intestinal obstruction
• Inflammatory bowel disease
• Pelvic inflammatory disease and other gynecological disorders
• Pntestinal adhesions
• Constipation
Diagnosis
For the most part, symptoms are related to disturbed bowel functions. Pain first, vomiting next and fever last has been described as classic presentation of acute appendicitis. Pain starts mid abdomen, and except in children below 3 years, tends to localize in right iliac fossa in a few hours. This pain can be elicited through various signs. Coughing causes point tenderness in this area (McBurney's point) and this is the least painful way to localize the inflamed appendix.
Physical Examination
Details about the abdominal pain are key to diagnosing appendicitis. The doctor will assess pain by touching or applying pressure to specific areas of the abdomen.
Responses that may indicate appendicitis include
Psoas sign
Psoas sign or "Obraztsova's sign" is right lower-quadrant pain that is produced with the patient extending the hip due to inflammation of the peritoneum overlying the iliopsoas muscles and inflammation of the psoas muscles themselves. Straightening out the leg causes the pain because it stretches the muscles, and flexing the hip into the "fetal position" relieves the pain.
Dunphy's sign
Increased pain in the right lower quadrant with coughing.
Bartomier-Michelson's sign
Increased pain on palpation at the right iliac region as patient lies on his/her left side compared to when patient was on supine position.
Aure-Rozanova's sign
Increase pain on palpation with finger in right Petit triangle typical in retroceacal position of the appendix.
Blumberg sign
Also referred as rebound tenderness. Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the pressure causes the severe pain on the site indicating positive Blumberg's sign and peritonitis.
Obturator sign
The right obturator muscle also runs near the appendix. Tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.
Laboratory Tests
Blood tests are used to check for signs of infection, such as a high white blood cell count. Ultrasonography and Doppler sonography provide useful means to detect appendicitis, especially in children and shows free fluid collection in right iliac fossa along with a visible appendix without blood flow in color Doppler
CASE
This is the case of a boy [H. R.] aged 13 years old. He came to me with his parents for acute pain in abdomen with vomiting he had fever, tenderness RIF on physical examination. Thirst for large quantity of water. Pain aggravate by motion. He advised for USG abdomen.
USG report was 6.5 mm calculi in left middle calyx. RIF showing distended appendix with impacted faecolith of outer wall 5.8 mm inner lumen 8.4 mm surrounded by free fluid around it. s/o probe tenderness +++.ACUTE APPENDICITIS.
On 19/02/11 he was prescribed R-1, R-38, PYROGENUM, BRYONIA, MERC. SOL.
He came back after seven days on 27/02/11with no pain, no tenderness, no vomiting. He advised for USG. Repeat the same medicines.
On 06/03/11 USG report was few thick walled gut loops are seen in the abdomen. Repeat same as above.
He came back on 12/03/11 he was given following medicines R-37, bryonia, merc. Sol, nux. Vom,pyrogenum. He also advised for USG.
ON 19/03/11 He came with USG report. Report was probe tenderness absent, RIF appendix could not be visualized probebbly reterococel. He was cured.
Dr. G. S. Bhatnagar
D.H.M.S. B.H.M.S.
Research officer
Sewa Mandir
Mobile: 9829978284
E-Mail: sewamandir@usa.net, drgsbhatnagar@gmail.com
Causes
Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of obstruction include
• Feces, parasites, or growths that clog the appendiceal lumen
• Enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
• Trauma to the abdomen
Symptoms
Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain.
The abdominal pain usually
• Occurs suddenly, often causing a person to wake up at night
• Occurs before other symptoms
• Begins near the belly button and then moves lower and to the right
• Is new and unlike any pain felt before
• Gets worse in a matter of hours
• Gets worse when moving around, taking deep breaths, coughing, or sneezing
Other symptoms of appendicitis may include
• Loss of appetite
• Nausea
• Vomiting
• Constipation or diarrhea
• Inability to pass gas
• A low-grade fever that follows other symptoms
• Abdominal swelling
• The feeling that passing stool will relieve discomfort
Symptoms vary and can mimic other sources of abdominal pain, including
• Intestinal obstruction
• Inflammatory bowel disease
• Pelvic inflammatory disease and other gynecological disorders
• Pntestinal adhesions
• Constipation
Diagnosis
For the most part, symptoms are related to disturbed bowel functions. Pain first, vomiting next and fever last has been described as classic presentation of acute appendicitis. Pain starts mid abdomen, and except in children below 3 years, tends to localize in right iliac fossa in a few hours. This pain can be elicited through various signs. Coughing causes point tenderness in this area (McBurney's point) and this is the least painful way to localize the inflamed appendix.
Physical Examination
Details about the abdominal pain are key to diagnosing appendicitis. The doctor will assess pain by touching or applying pressure to specific areas of the abdomen.
Responses that may indicate appendicitis include
Psoas sign
Psoas sign or "Obraztsova's sign" is right lower-quadrant pain that is produced with the patient extending the hip due to inflammation of the peritoneum overlying the iliopsoas muscles and inflammation of the psoas muscles themselves. Straightening out the leg causes the pain because it stretches the muscles, and flexing the hip into the "fetal position" relieves the pain.
Dunphy's sign
Increased pain in the right lower quadrant with coughing.
Bartomier-Michelson's sign
Increased pain on palpation at the right iliac region as patient lies on his/her left side compared to when patient was on supine position.
Aure-Rozanova's sign
Increase pain on palpation with finger in right Petit triangle typical in retroceacal position of the appendix.
Blumberg sign
Also referred as rebound tenderness. Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the pressure causes the severe pain on the site indicating positive Blumberg's sign and peritonitis.
Obturator sign
The right obturator muscle also runs near the appendix. Tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.
Laboratory Tests
Blood tests are used to check for signs of infection, such as a high white blood cell count. Ultrasonography and Doppler sonography provide useful means to detect appendicitis, especially in children and shows free fluid collection in right iliac fossa along with a visible appendix without blood flow in color Doppler
CASE
This is the case of a boy [H. R.] aged 13 years old. He came to me with his parents for acute pain in abdomen with vomiting he had fever, tenderness RIF on physical examination. Thirst for large quantity of water. Pain aggravate by motion. He advised for USG abdomen.
USG report was 6.5 mm calculi in left middle calyx. RIF showing distended appendix with impacted faecolith of outer wall 5.8 mm inner lumen 8.4 mm surrounded by free fluid around it. s/o probe tenderness +++.ACUTE APPENDICITIS.
On 19/02/11 he was prescribed R-1, R-38, PYROGENUM, BRYONIA, MERC. SOL.
He came back after seven days on 27/02/11with no pain, no tenderness, no vomiting. He advised for USG. Repeat the same medicines.
On 06/03/11 USG report was few thick walled gut loops are seen in the abdomen. Repeat same as above.
He came back on 12/03/11 he was given following medicines R-37, bryonia, merc. Sol, nux. Vom,pyrogenum. He also advised for USG.
ON 19/03/11 He came with USG report. Report was probe tenderness absent, RIF appendix could not be visualized probebbly reterococel. He was cured.
Dr. G. S. Bhatnagar
D.H.M.S. B.H.M.S.
Research officer
Sewa Mandir
Mobile: 9829978284
E-Mail: sewamandir@usa.net, drgsbhatnagar@gmail.com
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