Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a surgical emergency and many cases require removal of the inflamed appendix, either by laparotomy/laparoscopy or open approach in some developing countries.
The disease is slightly far more popular in males, with a male:female ratio of 1.4:1. In a lifetime, 8.6% of males and 6.7% of females could be expected to create acute appendicitis. Young age can be a risk factor, as nearly 70% of individuals with acute appendicitis are much less than 30 many years of age. The highest incidence of appendicitis in males is from the 10- to 14-year-old age group (27.6 instances per 10,000 population), although the highest female incidence is inside the 15- to 19-year-old age group (20.5 instances per 10,000 population). Individuals at extremes of age are additional likely to develop perforated appendicitis. Overall, perforation was present in 19.2% of circumstances of acute appendicitis. This number was considerably higher, even so, in sufferers under 5 and over 65 many years of age. Though much less typical in people more than 65 many years old, acute appendicitis inside elderly progresses to perforation more than 50% of the time.
- Pain (site, onset, duration, character, radiation, shifting, association with cough & movement).
- Nausea, vomiting, anorexia, fever, diarrhea.
- Urinary symptoms.
- OB/GYN History (Specially LMP).
- Pulse, blood pressure, temperature, respiratory rate, coated tongue.
- Tenderness & rebound tenderness in RIF.
- Rovsing’s Sign, Psoas Sign & Obturator Sign.
- P/R Examination & P/V Examination,
- Alvarado score
- Blood for Hb%, TLC. & DLC.
- Urine for pregnancy test in all females of child bearing age.
- Abdomino pelvic ultrasound in all females
- Abdominal ultrasound in males with complex signs (e.g. Palpable mass in RIF)
- X-Rays Abdomen Erect and supine Posture (Complex cases).
When diagnosed start
- Analgesia: Inj. diclofenac sodium 75 mg deep intragluteal/ Inj Nalbufin 5-10mg I/V.
- Inj. ampicillin 15 mg/Kg I/V ATD.
- Inj. gentamycin 1-1.5 mg I/V stat.
- Inj. metronidazole 7.5 –10 mg Kg I/V stat.
- No need of preoperative I/V fluids.
- Keep the pt. NPO.
- Inform the anaesthetist & theatre staff.
- Take the consent for operation, arrange medicines & pile up the patient’s chart.
- Shift the patient to theatre for
Guidelines for Appendicectomy:
- Palpate the anesthetized patient for Caecal gurgle and appendicular mass.
- Incision 2cm medial to anterior superior iliac spine at line joining from umbilicus to anterior superior iliac spine.
- Separate the internal oblique and transverses abdominal muscles. Abdominous close to rectus sheath.
- Ligate the appendix at base flush with Caecum avoiding the Caecal wall.
- Cut appendix where the conical curvature ends.
- Cauterize the mucosa pouting.
- Delayed primary closure of skin perforated appendix.
- Exploration of the mass by senior registrar
- Exclude ileocecal tuberculosis and carcinoma cecum.
- NPO for 2 hours then 2 oz fluids ½ hourly.
- NO I/V fluids.
- Two doses of I/V antibiotics (Gram +ve cover) in simple acute appendicitis.
- In case of perforated appendix, continue IV triple regimen for 48 hours and then continue oral antibiotics for 3 days