Appendicitis is an inflammation of the vermiform appendix.

1. Appendicitis
Dr.Ashutosh Kumar Singh

2. Introduction
Appendicitis is an inflammation of the vermiform ap
pendix.

3. Anatomy
• length = Avg. 10 cms
• Position = the base of the appendix is constant, being found at the confl
uence of the three taeniae coli of the caecum.
• Arterial supply = Appendicular artery branch of Ileo colic artery
• Venous drainage = Appendicular veins drain into ilio colic veins – Inferio
r mesentric veins
• Lymphatics vessels = Ileocaecal lymphnodes
• Functions = maturation of B lymphocytes

4. Arterial supply

5. Layers of appendix

6. Positions

7. Congenital anomalies
•Agenesis
•Duplication
•Diverticulum
•Left sided Appendix

8. Etiology
Obstruction
A) In the lumen = faecolith
B) In the wall = stricture , neoplasm
C) outside the wall = kinks, adhesions
D) Familial susceptibility

9. Pathology
OBSTRUCTIVE
A. Mucocele of appendix
B. Vascular congestion of appendix
C. Empyema of appendix
NON- OBSTRUCTIVE
A. Inflammation terminates by Suppuration
B. Gangrene
C. Fibrosis

10. Symptoms
Signs and symptoms of Appendicitis may include:
1. Sudden pain that begins around navel and often shifts to y
our lower right quadrant abdomen
2. Pain in Rt. lower quadrant
3. Nausea and vomiting
4. Loss of appetite
5. Fever that may worsen as the illness progresses
6. Constipation or diarrhoea

11. Signs
1. Murphy’s triad
2. Rovsing sign
3. Obturator sign / test
4. Psoas sign / test

12. Murphy’s Triad

13. Rovsing Sign

14. Psoas Sign
PSOAS TEST  +VE IN RETROCAECAL APPENDIC
ITIS

15. Obturator Sign
OBTURATOR TEST  +VE IN PELVIC APPENDICITI
S

16. ALVARADO SCORE

17. Investigations
1. CBC
2. Urine Analysis
3. Urea & electrolytes
4. Pregnancy Test
5. Supine abdominal radiograph
6. USG abdomen / Pelvis
7. CECT

18. Differential diagnosis

19. Treatment
Conservative management
1. IV Antibiotic
2. Antipyretic
3. Analgesic
4. Antacid
Surgical management
(Appendicectomy )

20. When to operate??
Criteria for stopping conservative treatment of an appendix mass
• A rising pulse rate
• Increasing or spreading abdominal pain
• Increasing size of the mass

21. Complications
1. Rupture
2. Mass (phlegmon)
3. Abscess
4. Suppurative pylephlebitis