Appendicitis
Original Editors - Carolyn Little & Ginny Tibbs from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Genevieve Tibbs, Carolyn Hall, Leana Louw, Elaine Lonnemann, Wendy Walker, Kim Jackson, Lucinda hampton and WikiSysop
Definition/Description[edit | edit source]
Appendicitis is described as the inflammation of the veriform appendix1. Obstruction, inflammation, or infection can cause the appendix to rupture leading to peritonitis1. This condition usually requires surgery as its medical management due to the fact that acute appendicitis can often be life threatening. Appendicitis is most commonly seen in adolescents and young adults1.
Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
The following list outlines some of the common signs and symptoms of typical acute appendicitis:
- Pain preceding nausea and vomiting
- Low grade fever
- Dysuria
- Pain in umbilical region that localizes in RLQ
- Pain referral to groin or thigh
- Pain comes in waves and is aggravated by movement
- Patients bend over, tense abdominal muscles, lie down, or flex hips to relieve tension over abdomen
- Anorexia
- Tense, rigid abdomen2
- Aggravating factors: movements that increase abdominal pressure (cough, walk, laughing)2
- Positve McBurney's point
- Positive Rebound Tenderness test
Atypical appendicitis may not presnt with the classical signs and symptoms listed above. These abnormal symptoms could present with decreased pain intensity and localization, less discomfort experienced when coughing or walking, and/or pain that localizes to the left side of the body2. In older adults, confusion may be the first sign of an acute event2.
Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values2[edit | edit source]
Diagnostic testing is often indicated for individuals suspected of having appendicitis. Medical imaging such as CT scans or sonograms are used to help confirm possible appendicitis. Additional laboratory tests utilzed are urine analyses or complete blood counts. Patients who present with typical appendicitis will have an elevated WBC count > 20,000 mm3. Physicians will also perform a histological examination of the resected appendix for further confirmation of the condition. Iliopsoas and obturator muscle tests are administered to rule out potential abcesses or insults to muscle integrity.
Etiology/Causes[edit | edit source]
In 50% of appendicitis cases, there is no known cause for the inflammation and enlargement of the appendix. Approximately 1/3 of appendicitis cases are obstruction related (tumors, fecaliths, parasites, or lymphoid hyperplasia). Obstruction of the appendix causes inflammation of the mucosa lining. Swelling of the glandular tissue leads to distention of the appendix and increased intraluminal pressure. When the intraluminal pressure excessed venous pressure ischemia to the local tissue occurs. Furthermore, microabcesses leads to necrosis of the tissue and the appendix can perforate within 24-48 hours. Invades
• no known cause for 50% cases
• 1/3 obstruction related (tumor, fecalith, parasites, lymphoid hyperplasia)
• 20% of people who have emergency appendectomies have normal appendix under tissue pathological examination
• infection causing enlarged lymph nodes
• appendix is lymphatic tissue- glandular tissue increases in the appendix and obstructs the lumen
• CD of ileum, ulcerative colitis
Pathogenesis
• Obstruction leads to inflammation of mucosa- swelling and hypermia of veriform appendix
• Increased secretions/obstruction distends appendix, intraluminal pressure rises = exceeds venous pressure =venous stasis and ischemia
• Neutrophil accumulation- microabcesses
• Infected necrotic wall becomes gangrenous and may perforate in 24-48 hours
• Mucosa ulcerates and allows invasion of bacteria
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
The following diseases can present with similar signs and symptoms as appendicitis1:
- Chron's disease
- Duodenal ulcer
- Gallballder attacks
- Kidney infection
- Right lower lobe pneumonia
- Ruptured ectopic pregnancy
- Twisted ovarian cyst
Case Reports/ Case Studies[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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