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Appendix (Introduction)

  • Appendix – a vestigial organ, is a blind ended muscular tube of variable length (average 7 to 10 cm) and variable circumference (1 to 5 mm).
  • It is a part of caecum where three taeniae coli merges.
  • Its mesoappendix is variable having the appendicular artery (a branch of ileocolic artery) at its margin.
  • Lymph drainage is to ileocolic lymph nodes.
  • Usually the base of appendix is at constant position (Mc Burney’s point) while its body is at variable positions (retrocaecal, pelvic, paracaecal, subcaecal, pre & postileal) so add in the difficulty of its diagnosis , as is true for abnormal position of caecum e.g. situs inversus viscerum.

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Clinical diagnosis of appendicitis

  • It is a more clinical diagnosis than laboratory investigations.
  • Common history is poorly localised colicky abdominal pain at peri-umbilical region, associated with anorexia, nausea, occasionally vomit than this pain shift to right iliac fossa as somatic pain.
  • On examination local abdominal tenderness, rebound tenderness, may or may not muscle guarding are important signs associated with low grade pyrexia and tachycardia.
  • Pointing sign, Rovsing’s sign, psoas sign, obturator sign may help in diagnosis of appendix at different location.
  • The clinical features of appendicitis varies according to the position of appendix as in retrocaecal , pelvic and at ileum etc and due to mal position of caecum (subhepatic) as well.
  • Clinical features also varies in obese, in pregnancy and at different ages as in infants, adult and elderly.

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Differential diagnosis of appendicitis These condition must be consider.

  • In children
    gastroenteritis, tonsil tummy,  mesenteric adenitis, meckel’s diverticulitis, intussusception, lobar pneumonia etc,
  • In adult
    Right ureteric colic, regional enteritis, perforated peptic ulcer, pancreatitis, torsion of testis, regional ileitis  etc.
  • In adult female
    Pelvic inflammatory disease,, ectopic pregnancy (ruptured  or un ruptured), torsion or rupture of ovarian cyst, midcyclic bleeding, endometriosis, pyelonephritis,  acute cholicystitis etc.
  • In elderly
    Intestinal obstruction, colonic carcinoma, diverticulitis, mesenteric infarction etc.
  • Rare differential diagnosis are:-
    Preherpatic pain of right 10th and 11th dorsal nerves, abdominal crises of diabetes mellitus, typhlitis , spinal conditions e.g., tuberculosis, metastatic carcinoma,  multiple myeloma, osteoarthritic spine, osteoporotic vertebral collapse etc.

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Investigations in appendicitis

  • Routine
    -Blood complete picture
    -Urinalysis
    -Urea
    -Sugar
    -Ultrasonography
  • Selective
    -X ray plain abdomen in standing including diaphragm
    -Contrast-enhanced CT scan of abdomen and pelvis
    -Electrolytes
    -Pregnancy test