Appendicitis overview: Difference between revisions
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Laparoscopic appendectomy is the treatment of choice for appendicitis. | Laparoscopic appendectomy is the treatment of choice for appendicitis. | ||
Revision as of 16:56, 14 August 2012
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Appendicitis Microchapters |
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Appendicitis On the Web |
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American Roentgen Ray Society Images of Appendicitis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Appendicitis is a condition characterized by inflammation of the appendix. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. In untreated cases, mortality is high mainly due to peritonitis and shock. Appendicitis is usually accompanied by abdominal pain, anorexia, fever, and nausea or vomiting
Historical Perspective
Appendicitis was first officially described by Reignald J. Fitz of Harvard University in 1886. Since that time, the appendectomy has become one of the most common surgical procedures of our time. The laparoscopic appendectomy was invented in 1980, and has led to reduced length of hospital stay, a decreased risk of infection, and a reduction in post-operative pain.
Classification
Appendicitis may be classified at three levels. As appendicitis often results from appendiceal obstruction leading to necrosis and infection, it may be classified based on the cause of the the obstruction. It also can be classified based on the organism causing this infection, or on whether it is perforating or non-perforating.
Pathophysiology
Appendicitis is caused by the obstruction of the tubular space inside the appendix. This initial problem is compounded into a cascade of events that lead to the inflammation of the appendix and the obstruction of the blood vessels supplying it, and infection. Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components. If the disease is not treated, eventually the appendix will rupture and can lead to death.
Causes
Appendicitis is mainly caused by the retention and obstruction of fecal matter, parasitic or bacterial infections of the appendix, and by physical damage to the appendix.
Differentiating Appendicitis from other Diseases
Appendicitis presents with pain near the navel, specifically the right lower quadrant of the abdomen. Because it is mainly characterized by different variants in type of abdominal pain, appendicitis must be differentiated from other diseases and disorders causing similar symptoms.
Epidemiology and Demographics
Appendicitis is a common disease in both Europe and America with about 100 people per 100,000 per year developing cases of appendicitis. Younger people, in the age group of 10-19, have the highest rates of developing appendicitis. Males are more likely than females to develop appendicitis. Whites are more likely than nonwhites to develop appendicitis.
Diagnosis
Patients with appendicitis commonly present with pain near the navel that eventually localizes to the right iliac fossa, loss of appetite, fever, nausea, and vomiting. Physical examination will mostly be focused on abdominal findings. The patient may be ill appearing, in pain, with a fever and mild tachycardia. Even minimal pressure on the abdomen may elicit a marked response from the patient due to pain.
Treatment
Laparoscopic appendectomy is the treatment of choice for appendicitis.