Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.

1. Appendicitis.
The appendix is a thin tube that is joined to the large intestine. It sits in the
lower right part of your belly (abdomen). When you are a young child, your
appendix is a working part of your immune system, which helps your body
to fight disease. When you are older, your appendix stops doing this and
other parts of your body keep helping to fight infection.

2.  Pathophysiology and epidemiology
•Inflammation of the vermiform (aka caecal) appendix, usually secondary to a
faecolith obstruction with subsequent bacterial overgrowth (B. fragilis, E. Coli).
•Lifetime risk: 1 in 15.

3.  Signs:
•Tenderness may be localized at McBurney's point, one third of the way between the
right ASIS and umbilicus.
•Rovsing's sign: RIF pain on pressing the LIF.
•Psoas sign: pain on extending hip (if retrocecal appendix).
•Cope (aka obturator) sign: pain on flexion and internal rotation of the right hip.

4.  Symptoms:
•Anorexia is usually the first sign, followed by abdominal pain then vomiting.
•Abdo pain is initially visceral colicky pain in the umbilical region, which then moves to
the right iliac fossa (RIF) and become constant. The RIF pain reflects inflammation
affecting the tissue and peritoneum surrounding the appendix.
•RIF peritonism: pain on moving or coughing, guarding, rebound tenderness.
•Fever, though usually mild. A high fever suggests abscess formation or perforation.

5.  Full body image of appendicitis

6.  Image of infected appendix

7.  Complications:
•Untreated, it can lead to perforation, generalized- peritonitis, and/or abscess
formation.
•Appendix mass: omentum and small bowel adhere to an inflamed appendix.

8.  Investigations:
•Diagnosis is usually clinical.
•Bloods: ↑WBC, ↑CRP.
•Urine: may contain white cells.
•Abdo-pelvis CT is the best imaging tool, but often not required. Ultrasound is less sensitive
but an acceptable alternative e.g. in pregnancy, pediatrics.

9.  Management:
Surgery:
•Appendectomy is the definitive treatment.
•Relative to open appendectomy, laparoscopic appendectomy leads to fewer
complications (post-op pain, abscess formation, ileus) and shorter hospital stay. In
pregnancy, however, open is safer.
•Open appendectomy is usually through a gridiron incision at Mc Burney's point,
perpendicular to the spinoumbilical line. Alternative is the transverse Lanz incision,
which has better cosmesis.

10. Antibiotics:
•Antibiotics IV before surgery and for 24 hours after. Give urgently if perforated.
•Most cases of uncomplicated appendicitis would resolve with 10 days
antibiotics alone, but surgery is performed due to the risk of recurrence (without
surgery, 25% within 1 year and 40% within 5 years) and – in part – because of
tradition.
 Management:

11. Managing appendicitis complications:
•Abscess can be treated with IV antibiotics and CT-guided drainage.
•Appendix mass is treated with antibiotics initially and appendectomy when settled.
 Management:

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