Acute appendicitis is the most common acute surgical condition of the abdomen. It involves inflammation and infection of the appendix. The appendix arises from the cecum in the right lower quadrant of the abdomen. Clinical diagnosis is based on symptoms of shifting abdominal pain, anorexia, vomiting, and localized tenderness in the right lower quadrant. Treatment involves appendectomy to remove the infected appendix.

1. Acute Appendicitis The most common acute surgical condition of the abdomen Anatomy , Pathophysiology , Clinical Diagnosis and Principles of Treatments

2. Anatomy Rises from cecum 6 to 10 cm Vermiform Right lower quadrant Mesoappendix Appendicular A. & V. Many lymph follicles

3. Anatomy (various position) Pelvic Retrocecal Retroileal Left lower quadrant Right lower quadrant

4. Etiology and Pathogenesis Obstruction of the lumen Hypertrophy of lymphoid follicles Fecaliths Foreign bodies Inflammatory strictions Others Fever, tachycardia, and leukocytosis Vein Continuing secretion & Bacteria multiplication Intraluminal pressure increases Impairment of blood supply & endotoxins Pain Distention Artery Engorgement Mucosa damaging Bacterial invasion Serosa involved Ellipsoidal infarcts Characteristic shift in pain to RLQ Perforation Abscess Generalized peritonitis Nausea & vomiting

5. History Physical findings Laboratory examinations Clinical Diagnosis

6. Clinical Diagnosis very constant after the onset of pain The sequence of symptoms Abdominal pain->Anorexia & Vomiting (if happens) Obstipation, Diarrhea Variations Left lower quadrant Long appendix Flank or back pain Retrocecal appendix Suprapubic pain Pelvic appendix Testicular pain Retroileal appendix Malrotation puzzling pain patterns Symptoms Abdominal pain Typical shifting abdominal pain Anorexia Vomiting Generalized Lower epigastrium Umbilical area Right lower quadrant

7. Clinical Diagnosis Signs Vital signs T, P normal or slightly elevated Somatic Position lie supine, thighs drawn up Classic RLQ signs Tenderness at or around McBurney’s point Rovsing’s sign Psoas sign Obturator sign Rectal examination Rebound tenderness Cutaneous hyperesthesia Muscular resistance Variations

8. Clinical Diagnosis Laboratory Findings Leukocytosis Urinalysis Radiographic studies Plain films of the abdomen Ultrasonography CT Laparoscopy

9. Essentials of Diagnosis Shifting abdominal pain Gastrointestinal symptoms Localized abdominal tenderness Leukocytosis Systemic symptoms

10. Differential Diagnosis Adult Acute gastroenteritis Cholecystitis Pyelitis Salpingitis Tubo-ovarian abscess Ruptured ovarian cyst Young children Mesenteric adenitis Intussusception

11. Principles of Treatments Appendectomy Antibiotics Laparoscopic Appendectomy Nonoperative therapy

12. Acute Appendicitis Anatomy Pathophysiology Clinical Diagnosis Principles of Treatments

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