Appendicitis

Inflammation of the appendix, the blind ended vestigial tube connected to the cecum (proximal portion of the large intestine).

  • predominantly in those 20-30 years of age
  • can be seen in any age group

 

Etiology

  • idiopathic
  • obstruction of appendix lumen by fecal pellet
  • twisted, constricted area of appendix or adjoining bowel area

 

Pathophysiology

  • obstruction
  • mucus drainage and flow impeded
  • increased intraluminal pressure
  • perfusion impeded due to pressure
  • ischemia
  • tissue necrosis
  • bacterial invasion of appendix wall from appendix lumen
  • Complication: appendix rupture leading to peritonitis

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Manifestation

  • Nausea
  • Vomiting

 

Pain Specifics

  • Pain commences in epigastric region or umbilical region
  • R lower quadrant pain later in progression (focused at appendix)
  • Pain terminates @ McBurney’s point – midpoint b/t iliac crest and umbilicus
  • Guarded, Rebound pain

 

McBurney’s point: point over the right side of the abdomen that is one-third of the distance from the ASIS (anterior superior iliac spine) to the umbilicus (the belly button). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum.

 

Diagnosis

  • Hx
  • Px – physical exam
  • Ultrasound
  • CT scan

 CT Scan below showing appendicitis:

Tx:

  • appendectomy within 24-48hrs of pain onset
  • delay may result in rupture and peritonitis

Martin, Glenn and Porth, Carol, Mattson. 2009. Pathophysiology Concepts of Altered Health States. 8th ed. Lippincott Williams and Wilkins. Philadelphia

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