The document provides a comprehensive overview of acute appendicitis, detailing its causes, clinical features, investigations, treatment options, and potential complications. It highlights the importance of a scoring system, specifically Alvarado's scoring, for determining patient management. Additionally, it outlines a treatment algorithm and summarizes relevant surgical education aspects related to the condition.

1. AN OVRVIEWDr.B.Selvaraj MS;Mch;FICS;
“Surgical Educator”
Malaysia
ACUTE APPENDICITIS
RLQ PAIN

2. ACUTE APPENDICITIS
Objectives
 Causes of RLQ Pain
 Etiology
 Pathology
 Clinical features- Symptoms & Signs
 Investigations
 Scoring System
 Treatment
 Complications
 Mindmap
 Algorithm for RLQ Pain
 Treatment Algorithm for Ac Appendicitis

3. ACUTE APPENDICITIS
Causes of RLQ Pain
 Acute Appendicitis
 Ectopic Pregnancy
 Twisted Ovarian Cyst
 Pelvic Inflammatory
Disease- PID
 Endometriosis
 Tubo-Ovarian
Pathology
 Mittlesmerz
In Females
 Acute Appendicitis
 Rt Ureteric Calculus
 Perforated DU-
Valentino Appendicitis
 Ac Cholecystitis
 Ac Pancreatitis
 Crohn’s Disease
 Cecal Diverticulitis
 Inferior Wall MI
 Lower Lobe Pneumonia
In Males In Children
 Acute Appendicitis
 Intussusception
 Meckel’s Diverticulitis
 Mesenteric Lymphadenitis

4. ACUTE APPENDICITIS
ETIOLOGY
 Obstructive:
1. Fecolith
2. Worms- Enterobious Vermicularis
3. Lymphoid Hyperplasia in Children
 Non-Obstructive:
1. Catarrhal- infection

5. ACUTE APPENDICITIS
PATHOLOGY

6. ACUTE APPENDICITIS
SYMPTOMS
MURPHY’S
TRIAD

7. ACUTE APPENDICITIS
SIGNS
 RIF Tenderness in McBurny’s
point
 RIF Rebound Tenderness,
Release tenderness or
Blumberg’s sign
 Guarding/Rigidity
 Cope’s Psoas Test
 Cope’s Obturator Test
 Rovsing’s Sign
 Hyperasthesia in Sherren’s
Triangle
Obturator Test

8. ACUTE APPENDICITIS
SIGNS
 RIF Tenderness in McBurny’s
point
 RIF Rebound Tenderness,
Release tenderness or
Blumberg’s sign
 Guarding/Rigidity
 Cope’s Psoas Test
 Cope’s Obturator Test
 Rovsing’s Sign
 Hyperasthesia in Sherren’s
Triangle
Obturator Test

9. ACUTE APPENDICITIS
INVESTIGATIONS
 Lab investigations:
1. Total WBC and Differential counts
2. C-Reactive Protein- CRP
2. Urine- FEME if positive for C&S
3. B- HCG to R/O pregnancy
 Imaging studies:
1. CXR- Erect or AXR including both side diaphragm to R/O Pneumoperitoneum
2. USG-To R/O any other pathology in women of child bearing age group
3. USG-To confirm Appendicitis
4. CECT abdomen

10. ACUTE APPENDICITIS
AXR

11. ACUTE APPENDICITIS
USG ABDOMEN

12. ACUTE APPENDICITIS
CECT- ABDOMEN

13. ACUTE APPENDICITIS
ALVARADO’S
SCORING
 Nemonic: MANTRELS
 If Score is < 4- discharge patient
 If Score is 5 to 7- admit for
observation
 If Score is 8 to 10- Straight away
surgery

14. ACUTE APPENDICITIS
TREATMENT
 If simple Appendicitis Open/Lap
Appendicectomy
 If Perforated Appendicitis Exploratory
Laparotomy, Appendicectomy & Peritoneal
toileting
 If Appendicular Abscess < 5cms USG
guided Needle aspiration or tube drain
If >5cms Open drain
 If Appendicular Lump:
- Oschner’s Sherren’s Regimen of
Conservative treatment
- NPO
- IVF
- IV broad spectrum Antibiotics
- Analgesics & Anti-inflammatory drugs
- Vital Signs Q2H

15. ACUTE APPENDICITIS
TREATMENT

16. ACUTE APPENDICITIS
COMPLICATIONS

17. ACUTE APPENDICITIS
MIND MAP

18. ACUTE APPENDICITIS
Algorithm For RLQ PAIN

19. ACUTE APPENDICITIS
Algorithm For Ac Appendicitis

20. Peripheral Arterial Diseases(PAD)