2. Presentation On
Appendicitis

3. Presented To
Dr.Ghazala Shaheen
BEMS, Ph.D(Clinical Therapeutics)
Lecture of Clinical Therapeutics
College of Conventional Medicine
The Islamia University of Bahawalpur

4. Presented By
Dr.Noshair Adil Ch
BEMS RMP DEMS

5. Contents
 Appendicitis
 Appendix
 Path physiology
 Causes
 Clinical Features
 Diagnosis
Clinical
Blood and Urine Test
Imaging
 Treatment
o Non Surgical
o Surgical

6. 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

7. 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.

9. Path physiology of Appendicitis
Lumen Obstruction(Any hard thing,feaces,hard foof material)
Bacterial Invasion
Inflammation
Thrombosis In Appenidicular artery
Necrosis

10. 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

11. 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

12. Diagnosis
Clinical
Blood and Urine Test
Imaging
Pathology
Differential diagnosis

13. 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

14. 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

15. 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

16. 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.

17. 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

18. Management
 Non Surgical
 Surgical
 Antibiotics
 Pre surgery
 Anti-Inflammatory
 After surgery
 Anti-Emetic
 Appendectomy
 Fluid Replacement
 Laparotomy
Therapy

19. 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

20. 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

21. Non Surgical
 Anti-emetic
Arq-e-badian
It is used as Anti-emetic
Dosage:40 milliliters
(One fourth tea cup) twice a day

22. Non Surgical
 Fluid Replacement Therapy
Inj: Ringer Lactate 1000ml I.v Stat

23. 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

24. 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.

25. 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