Acute appendicitis is caused by inflammation of the appendix. Common symptoms include abdominal pain that starts around the belly button and moves to the lower right area, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, low fever, and abdominal swelling. Diagnosis involves symptoms, physical examination looking for rebound tenderness and guarding, blood tests, abdominal x-ray, ultrasound, and in some cases CT scan. Treatment is usually surgical removal of the appendix, either through open surgery or laparoscopically. Antibiotics may be given before or after surgery depending on whether the appendix has ruptured. People with compromised immune systems or other medical issues require special consideration.

1. Acute Append icitis

2. Acute Append icitis Symptom 1. Abdominal pain first around the belly button, then moving to the lower right area 2. Loss of appetite 3. Nause a Vomiting 4. Constipation or diarrhea 5. Inability to pass gas 6. Low fever ( Begins after other symptoms ) 7. Abdominal swelling

3. Diagnosing Appendicitis 1. Symptoms ** 2. PE ** 3. Blood tests (dehydration or fluid and electrolyte ) 4. Abdominal X-Ray 5. Complete blood count 6. Urinalysis 7. Ultrasound 8. Chest X-ray

4. Physical examination Rebound tenderness and Guarding. PR The doctor may also move the patient's legs to test for pain on flexion of the hip ( P soas sign), pain on internal rotation of the hip (obturator sign), or pain on the right side when pressing on the left (Rovsing's sign).

5. Indication for admission 1. D iagnose appendicitis 2. Clinical sign R/O A ppendicitis

6. Other conditions can mimic appendicitis ? - Meckel's diverticulitis - Pelvic inflammatory disease - Right-sided diverticulitis - Kidney diseases. Inflammatory disease of right upper abdomen

7. The Surgical Procedure Open operation Laparoscopic technique.

8. Recovery from the Operation - Open Appendectomy Will be up and walking within six hours. Expect to be discharged barring complications in 1 – 2 days. - Laparoscopy Will most likely be discharged on the day of your operation.

9. Indication for Antibiotic 1 .D iagnosis is uncertain =>NPO & Non treat antibiotics 2. Non Ruptures appendicitis => Non treat or treat A ntibiotic Pre– O peration only 3. Rupture (Peritonitis) => Treat antibiotic to control the infection at surgery & P ost- op 1-3 days.

10. Appendiceal phlegmon or Abcess PE => Right lower quadrant – RLQ Rx. => Conservative treatment with antibiotic next 6 wk.- 3 month to elective appendectomy but non respond antibiotic - severe => Drain - non severe => surgery

11. People with Special Concerns 1. Immunosuppressive therapy such as steroids 2. Received a transplanted organ 3. Infected with the HIV virus 4. People with diabetes 5. Cancer or Receiving chemotherapy 6. Obese people, Pregnant women ,Infants, Young children and the elderly have particular issues