| ID | 233 |
|---|---|
| Name | ACUTE APPENDICITIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: 1. Blood for TC. DC TC-more than 11000 Leucocyte > 80% 2. Urine R/M/E, X-ray KUB 3. Abdominal ultrasound and/or CT scaning- both are useful in diagnosing appendicitis and excluding other differential diagnosis. 4. Pregnancy test- in female. Differential diagnosis: 1. All conditions presenting acute abdominal pain (e.g exaggerated peptic ulcer, intestinal obstruction, acute pancreatitis, peptic ulcer perforation, diverticulitis, Crohn’s ileitis, intestinal perforation in enteric fever, perforated colonic cancer, mesenteric adenitis, carcinoid of the appendix etc.) 2. Gastroenterisis 3. Ureteral colic or pyelonephritis 4. Acute salpingitis or tubo-ovarian abscess 5. Twisted ovarian cyst 6. Ruptured ectopic pregnancy 7. Sudden onset of lower abdominal pain in the middle of the menstrual cycle suggesrs mittelschmerz |
| Management | Management: Operative treatment: Patient with acute appendicitis, should be treated by emergency appendicectomy (within 24 hours), by conventional laparotomy or by laparoscopic techniques. Prior to surgery, patient should be given parenteral systemic antibiotics. Conservative treatment: If an appendix mass is present & the condition of the patient is not satisfactory or where the facilities for operation is not available, then conservative treatment may be allowed (Ochsner Sherren regimen). 1. History of onset is noted by hours. 2. Physical signs are recorded in the clinical notes in diagrammatic form. 3. Chart for pulse, temp. & vomiting. 4. Diet-nothing by mouth. 5. Intravenous glucose saline. 6. Inj. Pathedine or Morphine as analgesic. 7. parenteral systemic antibiotics. 8. Bowels should be cleared by a glycerine suppository after 4/5 days. |
| Introduction | |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Symptoms: 1. Severe pain around the umbilicus or in the epigastrium which shifts to the right iliac fossa after a few hours. 2. Nausea, vomiting & anorexia. 3. Mild rise of temperature (< 38°C)- after 6 hours. Signs: 1. Patient is flushed and toxic. 2. Increase pulse rate and temparature. 3. Tenderness in the right iliac fossa. (In loin- in case of retrocecal type). 4. Rebound tenderness in the same regions (Blumberg’s sign.) 5. Localized rigidity and tenderness in the right lower quadrant, can be elicited with gentle palpation with one finger (McBurney’s point). 6. Sharp pressure in the left iliac fossa elicits pain in the right iliac fossa-(Rovsing’s sign). 7. Pain on extension of hip joint. (Psoas sign) in retrocecal type. 8. Pain on flexion and medial rotation of thigh. (Copes obturator test- intrapelvic type) 9. Rectal examination- tenderness and a mass in the pouch of Douglas-intrapelvic type. Don’t forget to examine- 1. Testis- in case of young to exclude torsion. 2. Hernial orifices- to exclude strangulated hernia. 3. Female- P/V exam, to exclude ectopic pregnancy. |
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