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APPENDICITIS TREATMENT

What is appendicitis?

When the inner lining of the vermiform appendix gets inflamed, it is known as appendicitis. Deemed as one of the most common causes of abdominal pain, appendicitis is a clinical emergency.

Causes

The obstruction of the appendiceal lumen causes appendicitis. Lymphoid hyperplasia is the cause of luminal obstruction. Lymphoid hyperplasia develops secondary to inflammatory bowel disease or IBD. Obstruction releases pressure in the lumen. It also enlarges due to infections (bacterial, fungal and viral), fecal stasis, fecaliths (fecal debris and calcium salts are layered within the appendix). Other causes associated with the condition are gastroenteritis, Crohn’s disease, measles, amebiasis and mononeucliosis.

Symptoms

  • Anorexia
  • Abdominal pain- abdominal pain starts at the periumbilical region or epigastric area and migrates to the right lower quadrant
  • Nausea
  • Vomiting – vomiting preceding the pain is indicative of intestinal obstruction
  • Diarrhea
  • Constipation

Diagnosis

Physical examination will reveal right lower quadrant tenderness, rigidity and guarding and pain on percussion. Left lower quadrant tenderness is also manifested. An inflamed hemiscrotum is noticed in male children and infants. Internal rotation of the thigh elicits pain in case of pelvic appendicitis. In retroperitoneal and retrocecal appendicitis, extension of the right thigh elicits pain.

CBC indicates: WBC count < 10,500 cells/ul and neutrophils < 75% C-Reactive protein or CRP levels > 1 mg/dL indicate appendicitis

CRP sensitivity test is done for patients who have to undergo appendectomy

Liver and pancreatic function tests to evaluate bilirubin, transaminases, alkaline phosphatase etc. are done in patients who have no clarity in presentation

Urinalysis helps in distinguishing appendicitis from urinary tract infections

Urinary Beta-HCG differentiates appendicitis against early ectopic pregnancy

Urinary 5-HIAA is an indicator of acute and early appendicitis

Barium enema study is a single-contrast study done on an unprepared bowel will indicate incomplete filling of the appendix. Any spasm in the secum will suggest appendicitis.

Ultrasonography demonstrates a tubular, non-compressive structure, 7-9 mm in diameter

Radionuclide scanning requires drawing blood. Technitium labels are placed on the neutrophils and macrophages to be administered intravenously. Serial images of the abdomen and pelvis will indicate an inflamed appendiceal.

Abdominal sonography for KUB or kidneys, ureters and bladder are viewed for appendicitis

Medical management

Anitbiotics are administered to eliminate infection and avoid complications. Penicillins are considered as bactericidal antibiotics working against sensitive organisms to inhibit the synthesis of mucopeptide and the cell wall. Zosyn containing piperacillin and tazobactum sodium acts against gram-positive, gram negative anaerobic bacteria. Other anti-infective agents are ampicillin, sulbactum and tricarcillin.

Dr. Deepak issues consultations on appendicitis opting for elective surgery in acute cases.

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