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M. IQBAL RIVAI
ANATOMY
a blind muscular tube with mucosal, submucosal,
muscular and serosal layers.
end artery
Thrombosis
Necrosis
gangrenous appendicitis
Commonly:
behind the caecum (Retrocaecal)
On psoas muscle at or below pelvic brim (Pelvic)
Rarely:
Pre-ileal Post-ileal Paracaecal
Microscopic Anatomy
Aetiology
There is no unifying hypothesis regarding the
aetiology of acute appendicitis.
Signs
Pyrexia
Localised tenderness in the right iliac fossa
Muscle guarding
Rebound tenderness
Signs to elicit in appendicitis
Pointing sign
Rovsings sign
Psoas sign
Obturator sign
Special features, according to position of the
appendix
Special features, according to age
Infants
Appendicitis rare in infants < 36 months diagnosis is often
delayed incidence of perforation and postoperative morbidity
is higher than in older children.
Diffuse peritonitis can develop rapidly because of the
underdeveloped greater omentum
Children
It is rare to nd a child with appendicitis who has not vomited.
Children with appendicitis usually have complete aversion to food.
The elderly
Gangrene and perforation occur much more frequently inelderly
patients.
The obese
Obesity can obscure and diminish all the local signs of acute
appendicitis Delay in diagnosis
Pregnancy
Appendicitis the most common extrauterine acute
abdominal condition in pregnancy
the caecum and appendix are progressively pushed to the right
upper quadrant of the abdomen as pregnancy develops during
the second and third trimesters non-specic symptoms
Differential diagnosis
Investigation
Clinical examination
alvarado score
Abdominal x-ray
Barium enema
Abdominal ultrasound
Contrast-enhanced CT
scan
Treatment
Appendicectomy
Conventional appendicectomy
Removal of the appendix
Retrograde appendicectomy
Laparoscopic appendicectomy