The document provides an overview of acute appendicitis, focusing on its diagnosis, anatomy, and management strategies. It emphasizes the significance of clinical symptoms, laboratory findings, and imaging studies in diagnosing appendicitis, with the modified Alvarado score serving as a predictive tool. Management options include non-operative treatment for uncomplicated cases and multiple surgical approaches for appendectomy.

1. ACUTE APPENDICITIS
DR. S.P. GAYATHRE
PROF AND HEAD
DEPARTMENT OF GENERAL SURGERY
SMCH

2. INTRODUCTION
• M/C acute abdomen – young adults
• M/C emergency abdominal procedure
• First major procedure – Surgical resident.
• Despite advances – A clinical diagnosis
• Lifetime risk of appendicectomy
• 8.6 % - Males. 6.7 % females
• Young adults M/C
• Males : Females (3:2)

3. Anatomy
• Base constant – Confluence Taenia coli
• Taenia – continues as outer longitudunal
muscle of appendix.
• The average length -7.5 and 10 cm
• Appendiceal artery, branch of ileocolic
artery, branch of the superior mesenteric
artery which courses through the
mesoappendix
• Lymphatic drainage into ileocaecal lymph
nodes

6. Laboratory
studies
• Routine Full blood count:
leukocytosis with left shift - 90% of the cases
Higher leukocytosis - with gangrenous and perforated appendicitis
(∼17,000 cells/mm3)
• Urinalysis- to rule out nephrolithiasis
• Pregnancy test- mandatory in child bearing age
• Urea and electrolytes
• C-reactive protein

7. Migratory RIF pain 1
Anorexia 1
Nausea and vomiting 1
Tenderness (RIF) 2
Rebound tenderness 1
Elevated temperature 1
Leukocytosis 2
MODIFIED ALVARADO SCORE
score of 7 or more: strongly predictive of acute
appendicitis. (5–6): equivocal score

8. Imaging
studies
• Plain radiographs
• Ultrasound (US)
• Computed tomography (CT) scanning
• Magnetic resonance imaging (MRI)

9. USG
• An easily compressible appendix <5 mm in diameter generally rules out
appendicitis.
• Features on an ultrasound that suggest appendicitis include
Diameter of greater than 6 mm
Pain with compression,
Presence of an appendicolith
Increased echogenicity of the fat,
Periappendiceal fluid

10. CT-
scan
• Features on a CT scan that suggest appendicitis include
Enlarged lumen and double wall thickness (greater than 6 mm)
Wall thickening (greater than 2 mm)
Periappendiceal fat stranding
Appendiceal wall thickening and/or
An appendicolith

12. Management of
appendicitis
• Non-operative management
• Operative management

13. Non-operative management
– Uncomplicated
appendicitis
• Patients with uncomplicated (absence of appendicolith, perforation or
abscess) appendicitis.
• Bowel rest and intravenous antibiotics, often metronidazole and 3rd
generation
cephalosporin.
• One-quarter of patients initially treated conservatively -
require surgery within 1 year
>40 yrs – followed up – Malignancy risk.

14. Operative
management
• Open appendectomy -supine position.
• The choice of incision :
Oblique muscle-splitting incision (McArthur-McBurney)
Transverse incision (Rockey-Davis) or
Conservative midline incision

15. TREATMENT
Appendicectomy

16. APPROACHES
1. Gridiron incision.
2. Rutherford Morison’s incision.
3. Lanz crease incision.
4.Right lower paramedian incision/lower midline incision.
5. Laparoscopic.

17. Appendicectom
y

18. THANK YOU