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Acute appendicitis

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VOL: 99, ISSUE: 03, PAGE NO: 28


- Acute appendicitis can occur at any age, although it is more common in adolescents. When the condition is suspected, prompt action is necessary to avert possibly serious complications.


- Acute appendicitis refers to an acute inflammation of the appendix, a narrow sack (referred to as vermiform or ‘worm like’) that is attached to the caecum. The appendix has no known physiological function in humans.


- Appendicitis occurs more frequently in males.


- The aetiology of the condition is not known. Suspected causes relate to obstruction that leads to a build-up of pressure within the appendix. Such obstruction could be due to a hard mass of faeces or a foreign body.


- Appendicitis is the most common form of emergency requiring an operation and there are about 70,000 cases per year in the UK.


- In general, the incidence of the condition is falling.


- The patient experiences central abdominal pain near the umbilicus, moving to the right iliac fossa. There the pain becomes more constant.


- Movement exacerbates the pain and the patient will tend to lie still for pain relief.


- Rovsing’s sign: pain in the right iliac fossa when pressure is applied in the left iliac fossa.


- Tachycardia, flushed face and furred tongue.


- Anorexia, vomiting and pyrexia.


- Dysuria or diarrhoea can occur.


- Untreated appendicitis can lead to peritonitis and complications such as intra-abdominal abscess.


- Clinical examination.


- Rectal examination.


- Diagnostic laparoscopy.


- The standard treatment for acute appendicitis is appendicectomy, which can be performed via open or laparoscopic surgery.


- Antibiotic therapy postoperation.


- Fluid balance: the preoperative patient is usually resuscitated with intravenous fluids; the patient may require a nasogastric tube to prevent aspiration.


- Wound care: the wound may have been closed with dissolvable sutures or clips.


- Observe for postoperative complications such as wound infection and paralytic ileus.


- There should be a gradual reintroduction of fluids and diet.


- Postoperative recovery can be slower and more complex if peritonitis is present or suspected at the time of surgery.


- Laparoscopic and open surgery have been compared for suspected appendicitis.


- Research on the use of diagnostic laparoscopy in women with right iliac fossa pain aims to reduce the removal of normal appendices.


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