Appendicitis

Appendicitis is a condition characterised by inflammation of the appendix. While mild cases may resolve without treatment, many require laparotomy with removal of the inflamed appendix. Untreated, mortality is high, mainly due to peritonitis and shock when the inflamed appendix ruptures.

Diagnosis

Diagnosis is based on history and physical examination backed by blood tests and other diagnostic procedures.

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The classical physical finding in appendicitis is diffuse pain in the umbilical region which can become localised at McBurney's point if the inflammed appendix comes into contact with the parietal peritoneum. This point is located on the right-hand side one-third of the distance between the anterior superior iliac spine and the navel, or approximately one hand's width.

Related Topics:
Umbilical region - McBurney's point - Parietal peritoneum - Anterior superior iliac spine - Navel

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Other methods include a digital rectal exam, where a finger is inserted into the rectum - if there is right sided tenderness (where the appendix normally lies), it makes it more likely that the patient has appendicitis.

Related Topics:
Digital rectal exam - Rectum

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Other signs used in the diagnosis of appendicitis are the psoas sign (common in retrocecal appendicitis), the obturator (internus) sign, Blomberg's sign and Rovsing's sign.

Related Topics:
Blomberg's sign - Rovsing's sign

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Ultrasonography and Doppler sonography also provide useful means to detect appendicitis, but in a not neglectable minority of cases (15% approximately), especially those in an early stadium without fluid build-up, an ultrasonography of the iliac fossa region do not reveal abnormalities despite of present appendicitis. Yet, sonographic imaging can often distinguish between appendicitis and another disease with very similar symptoms, namely the inflammation of the lymph nodes near the appendix. In situations where a CT scan is easily and readily available, it is the preferred test of choice. A properly performed CT scan has a detection rate (sensitivity) of over 95%. What is looked for on CT scan is the lack of contrast(oral dye) in the appendix as well as signs of appendiceal enlargement, usually >6mm on cross section; there may also be evidence of inflammation in the so called "fat stranding". Ultrasounds are especially useful to assess for gynecologic causes of right lower quadrant abdominal pain in women as the CT scan is not the imaging modality of choice in this circumstance.

Related Topics:
Ultrasonography - Doppler sonography - Iliac fossa - Inflammation - Lymph nodes

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