Video:Appendicitis

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Definition

Appendicitis is inflammation of the appendix.[1]

Stomach colon rectum diagram-en.svg

Symptoms

Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite.[1] However, approximately 40% of people do not have these typical symptoms.[1]

Symptoms with rupture

Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall, and sepsis.[2]

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Causes

Appendicitis is caused by a blockage of the hollow portion of the appendix.[3] This is most commonly due to a calcified "stone", made of feces.[4]

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Etiology of blockage

Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage.[4]

X-ray showing fecalith which has caused appendicitis.jpg

Pathophysiology

This blockage leads to increased pressures in the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation.[4][5]

Acute Appendicitis.jpg

Necrosis

The combination of inflammation, reduced blood flow to the appendix, and distention of the appendix causes tissue injury, and tissue death.[6] If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to increased complications.[6][7]

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Diagnosis

The diagnosis of appendicitis is largely based on the person's signs, and symptoms.[5] In cases where the diagnosis is unclear, close observation, medical imaging, and laboratory tests can be helpful.[8]

McBurney's point.jpg

Imaging

The two most common imaging tests used are an ultrasound, and computed tomography (otherwise known as a CT scan).[8]

CAT scan demonstrating acute appendicitis.jpg

CT vs ultrasound

CT scan has been shown to be more accurate, than ultrasound in detecting acute appendicitis,[9] but with children and pregnant women, ultrasound may be used to limit radiation exposure. [8]

Treatment

The standard treatment for acute appendicitis is surgical removal of the appendix.[4][5]

Inflamed appendix.jpg

Open vs closed

This may be done by an open incision in the abdomen (called a laparotomy), or through a few smaller incisions with the help of cameras (which is called laparoscopy). Surgery decreases the risk of side effects, or death, associated with rupture of the appendix.[2]

Appendix-Entfernung.jpg

Antibiotics

Antibiotics may be equally effective in certain cases of non-ruptured appendicitis.[10]

Out of danger.jpg

Epidemiology

Appendicitis is one of the most common, and significant causes of severe abdominal pain, that comes on quickly. In 2015, about 11.6 million cases of appendicitis occurred, which resulted in about 50,100 deaths.[11][12]

Appendicitis world map-Deaths per million persons-WHO2012.svg

National burden in US

In the United States, appendicitis is the most common cause of sudden abdominal pain requiring surgery.[1] Each year in the United States, more than 300,000 people with appendicitis, have their appendix surgically removed.[13]

Appendicitis world map - DALY - WHO2004.svg

History

Reginald Fitz is credited with being the first person to describe the condition, in the english language literature, in 1886.[14]

Reginald Heber Fitz Ignaz Gaugengigl.jpg

References

  1. 1.0 1.1 1.2 1.3 Graffeo, Charles S.; Counselman, Francis L. (November 1996). "Appendicitis". Emergency Medicine Clinics of North America. 14 (4): 653–71. doi:10.1016/s0733-8627(05)70273-x. PMID 8921763.
  2. 2.0 2.1 Hobler, K. (Spring 1998). "Acute and Suppurative Appendicitis: Disease Duration and its Implications for Quality Improvement" (PDF). Permanente Medical Journal. 2.
  3. Pieper R, Kager L, Tidefeldt U (1982). "Obstruction of appendix vermiformis causing acute appendicitis. One of the most common causes of this is an acute viral infection which causes lymphoid hyperplasia and therefore obstruction. An experimental study in the rabbit". Acta Chirurgica Scandinavica. 148 (1): 63–72. PMID 7136413.
  4. 4.0 4.1 4.2 4.3 Longo, Dan L.; et al., eds. (2012). Harrison's principles of internal medicine (18th ed.). New York: McGraw-Hill. p. Chapter 300. ISBN 978-0-07174889-6. Archived from the original on 30 March 2016. Retrieved 6 November 2014. CS1 maint: discouraged parameter (link)
  5. 5.0 5.1 5.2 Tintinalli, editor-in-chief Judith E. (2011). Emergency medicine : a comprehensive study guide (7. ed.). New York: McGraw-Hill. p. Chapter 84. ISBN 978-0-07-174467-6. Archived from the original on 22 December 2016. Retrieved 6 November 2014. CS1 maint: discouraged parameter (link) CS1 maint: extra text: authors list (link)
  6. 6.0 6.1 Schwartz's principles of surgery (9th ed.). New York: McGraw-Hill, Medical Pub. Division. 2010. p. Chapter 30. ISBN 978-0-07-1547703.
  7. Barrett, ML; Hines, AL; Andrews, RM (July 2013). "Trends in Rates of Perforated Appendix, 2001–2010" (PDF). Healthcare Cost and Utilization Project Statistical Brief #159. PMID 24199256. Archived (PDF) from the original on 2016-10-20. CS1 maint: discouraged parameter (link)
  8. 8.0 8.1 8.2 Paulson, EK; Kalady, MF; Pappas, TN (16 January 2003). "Clinical practice. Suspected appendicitis" (PDF). The New England Journal of Medicine. 348 (3): 236–42. doi:10.1056/nejmcp013351. PMID 12529465.
  9. Shogilev, DJ; Duus, N; Odom, SR; Shapiro, NI (November 2014). "Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014". The Western Journal of Emergency Medicine (Review). 15 (7): 859–71. doi:10.5811/westjem.2014.9.21568. PMC 4251237. PMID 25493136.
  10. Varadhan KK, Neal KR, Lobo DN (2012). "Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials". The BMJ. 344: e2156. doi:10.1136/bmj.e2156. PMC 3320713. PMID 22491789.
  11. GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  12. GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  13. Mason, RJ (August 2008). "Surgery for appendicitis: is it necessary?". Surgical Infections. 9 (4): 481–8. doi:10.1089/sur.2007.079. PMID 18687030.
  14. Fitz RH (1886). "Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment". American Journal of the Medical Sciences (92): 321–46.