Acute appendicitis

The appendix is a narrow, hollow, blind-ended tube connected to the cecum. It has large aggregations of lymphoid tissue in its walls and is suspended from the terminal ileum by the mesoappendix.

The vermiform appendix is defined as a true diverticulum of the colon.

Etiology

There is no unifying hypothesis regarding the etiology of acute appendicitis. Decreased dietary fibre and increased consumption of refined carbohydrates may be important.

Anatomy

• Most common position of appendix is Retrocaecal.

• The base of the appendix is located at the convergence of the three taeniae coli at the tip of the cecum.

Blood supply

• The appendix is supplied by the appendicular artery, which is a branch of the ileocolic artery derived from the superior mesenteric artery.

• The vermiform appendix receives both sympathetic and parasympathetic innervation through the superior mesenteric plexus and vagus nerve.

Symptoms

• Pain

• Fever

• Nausea and vomiting

• Anorexia

Signs

• Tachycardia

• Tenderness at Mc burney’s point.

• Pointing sign:- Pointing at Mc burney’s point as a site of maximum tenderness.

• Rovsing sign:- Pressing of left iliac fossa causes pain in right iliac fossa.

• Psoas sign:- Flexion of right hip against resistance cause pain in right iliac fossa region.

• Obturator sign:- Pain due to Flexion and internal rotation of right hip.

Differential diagnosis

Investigations

• Increased total leucocyte count

• Increased neutrophils

• Increased C Reactive Protein

• Investigation of choice For Children:- Ultrasonography, For Adults:- CECT(Contrast Enhanced Computed Tomography)

• MANTRELS score for diagnosis of appendicitis is as follows:-

• Score <5 Less Likely

• Score 5-8 Confirm with USG

• Score 9-10 Highly likely

Treatment

• Conservative:- Which includes NPO(Nill Per Oral), IV fluids, and antibiotic cover

• Definitive:- Appendicectomy

References

• Bailey & Love’s Short Practice of Surgery

• Gray’s Anatomy

• Netter Atlas of Human Anatomy