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  1. 1. Presentation On Appendicitis
  2. 2. Presented To Dr.Ghazala Shaheen BEMS, Ph.D(Clinical Therapeutics) Lecture of Clinical Therapeutics College of Conventional Medicine The Islamia University of Bahawalpur
  3. 3. Presented By Dr.Noshair Adil Ch BEMS RMP DEMS
  4. 4. Contents  Appendicitis  Appendix  Path physiology  Causes  Clinical Features  Diagnosis Clinical Blood and Urine Test Imaging  Treatment o Non Surgical o Surgical
  5. 5. Appendicitis  Appendicitis is a condition in which your appendix becomes inflamed and fills with pus.  Appendicitis is an inflammation of the appendix  Appendicitis is common. Typical symptoms include abdominal pain and vomiting that gradually get worse over 6-24 hours
  6. 6. What and where is the appendix?  The appendix is a small dead end pouch, like a little tube, that comes off the caecum. The caecum is the first part of the large intestine. Just before the colon. The small intestine digests and absorbs food. The parts of the food that are not digested begin to be formed into faeces (motions) in the caecum.  The appendix is normally about 5-10 cm long and thin. The appendix appears to have no function.
  7. 7. Path physiology of Appendicitis Lumen Obstruction(Any hard thing,feaces,hard foof material) Bacterial Invasion Inflammation Thrombosis In Appenidicular artery Necrosis
  8. 8. Causes The main cause of appendicitis is Obstruction of Lumen of appendix Cause of Lumen Blockage  Any Foreign Material  Trauma  Infection  Intestinal Worm  Lymphadenitis  Stool
  9. 9. Clinical Features  Pain in upper abdomen that becomes sharp as it moves to the lower right abdomen.  Loss of appetite  Nausea and/or Vomiting soon after Abdominal Pain begins  Abdominal swelling  Fever of 99-102 degrees Fahrenheit  Inability to pass gas Almost half the time, other symptoms of appendicitis appear, including:  Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum  Painful urination  Vomiting that precedes the abdominal pain  Severe cramps  Constipation or Diarrhea with gas
  10. 10. Diagnosis Clinical Blood and Urine Test Imaging Pathology Differential diagnosis
  11. 11. Clinical Diagnosis  Aure-Rozanova sign Increased pain on palpation with finger in right Lumbar Triangle  Bartomier-Michelson's sign Increased pain on palpation at the right iliac region as patient lies on his/her left side compared to when patient was on supine position Supine Position
  12. 12. Clinical Diagonsis  Dunphy's sign Increased pain in the right upper quadrant with coughing  Obturator sign If an inflamed appendix is in contact with the Obturator Internus spasm of the muscle is called Obturator sign. It is demonstrated by flexing and internal rotation of the hip and pain is occur in Hypogastrium
  13. 13. Clinical Diagnosis  Sitkovskiy Sign Increased pain in the right iliac region as patient lies on his/her left side.  Psoas sign If an inflamed appendix is in contact with the Psoas major spasm of the muscle is called Psoas Sign. It is demonstrated by flexing and internal rotation of the right hip and pain is occur in Right lower quadrent
  14. 14. Blood Test and Urine Test  Complete Blood Count (CBC) is done to check for signs of infection. 70-90 percent of people with appendicitis may have an elevated white blood cells  Urine Analysis for Urinary Tract Infection. there is a possibility of a microscopic Pyuria the condition of urine containing pus, or Hematuria, urine containing red blood cells, caused by the proximity of the appendix to the Ureter and bladder in acute appendicitis.
  15. 15. Imaging  X–Ray  Ultrasound On USG free fluid collection in the right iliac fossa is to seen along with a visible appendix without blood flow  C.T Scane
  16. 16. Management  Non Surgical  Surgical  Antibiotics  Pre surgery  Anti-Inflammatory  After surgery  Anti-Emetic  Appendectomy  Fluid Replacement  Laparotomy Therapy
  17. 17. Non-Surgical  Antibiotics Plants  Glycyrrhiza Jaiphal(Myristica Fragrens) Dried Ripe Fruits of Jaiphal have antibacterial activity Cap: jaiphal 500mg 1+1+1 Joshanda-e-Istakhudos 1 packet X BD glabra(Malathi) Dried Roots of Glycyrrhiza glabra is used as a antibiotic Cap: Pepicone 500mg 1+1  Althaea officinalis(Khatmi) Root, leaves and flowers are used a antibiotic
  18. 18. Non-Surgical  Anti-Inflammatory  Zancid  Arq-e-Makooh It is used abdominal cramping by smoothing gastrointestinal tract,making itan antispasmodic. It Contain Zinger and Malathi Half tea Cup X BD  Glycyrrhiza glabra(Malathi) Glysyrrhizin acts as an anti-inflammatory to inhibit the breakdown of cortisol and also has antibacterial properties. Cap: Pepicone 500mg
  19. 19. Non Surgical  Anti-emetic Arq-e-badian It is used as Anti-emetic Dosage:40 milliliters (One fourth tea cup) twice a day
  20. 20. Non Surgical  Fluid Replacement Therapy Inj: Ringer Lactate 1000ml I.v Stat
  21. 21. Surgical Managment  Pre-Surgery The treatment begins by keeping the patient away from eating or drinking in preparation for surgery o Antibiotics Antibiotic such as Cefotaxime Na or Ciprofloxacine is given Intravenously
  22. 22. Surgical Treatment  Appendectomy The Surgical procedure for the removal of the appendix is called an Appendectomy  Laparotomy Laparotomy is the traditional type of surgery used for treating appendicitis. This procedure consists in the removal of the infected appendix through a single larger incision in the lower right area of the abdomen.
  23. 23. Surgical Treatment  Laparoscopic surgery The newer method to treat appendicitis is the laproscopic Surgery This surgical procedure consists of making three to four incisions in the abdomen, each 0.25 to 0.5 inches (6.4 to 12.7 mm) long. This type of appendectomy is made by inserting a special surgical tool called laparoscope into one of the incisions. The laparoscope is connected to a monitor outside the patient's body and it is designed to help the surgeon to inspect the infected area in the abdomen. The other two incisions are made for the specific removal of the appendix by