Acute appendicitis

notes and reflections dr. Claudio Italiano, internist


A polite request of the many surfers who have asked me to discuss it, we say that appendicitis is' acute appendix inflammation, a classic in general surgery!

This writer, young, age 26, fresh out of college, had to intervene to wrest a certain death of his godson eight years, edited by pediatrician for cystitis. When the boy came to my attention, the picture was dramatic dell'ascesso perforated appendix with evidence of peritonitis, abdominal wall resistance, fever over 39.5 ° C-40 ° C, vomiting, prostration. They had to operate in a hurry and have pus and fecal material was highlighted in the abdominal cavity and drained into the peritoneum, between the loops and into the excavation of Douglas, nauseating smell spread in the operating room. It took repeated washing with warm saline of intestinal loops. Promptly recovered the boy!



Meanwhile, to understand, we say that Appendix as it is the "tonsil" intestine, vermiform un'estroflessione that is hanging by the last section the appendix. The headquarters of the Appendix may differ from its position at the right iliac caecal seat back, pelvic and meso-celiac. The most important sign is the pain, intense in the right iliac fossa, often accompanied with vomiting or nausea alone trend. Usually fever also appears on 38 to 38.5 ° C, pulse full, coated tongue and tachycardic. Sometimes abdominal pain is localized around the navel. In the next 12-24 hours, the pain, which is the cardinal symptom of appendicitis, moves down, undermining the right iliac fossa

Causes: inflammation is generally caused by an obstruction inside the Appendix to the consequent stagnation of undigested material or hypertrophy of the appendiceal lymphoid follicles, which can increase the number and size under local or systemic infection ( infectious mononucleosis, measles, typhoid fever, Crohn's disease, respiratory infections, etc...) The appendiceal lymphoid follicles are hypertrophied in adolescence, but significantly reduced until it disappears around the sixth decades of life. For this reason, the occlusion Appendix adulthood is often related to the stagnation of a mass of solidified fecal material and inorganic salts (coprolita) or, more rarely, the presence of a foreign body (gall stones, tumors or parasites bowel, such as taenia solium, Ascaris lumbricoides, Enterobius vermicularis ..

.The visit should be laid with light palpation, hands heated plate placed in the abdomen, the abdomen was opened by the portion that does not hurt, that is, from the left iliac fossa and proceed up the gently descending colon, the transverse and finally falling down on the right side, to the right iliac fossa. The operator tries to appreciate and evaluate:

The so-called pain caused, located in the right iliac fossa, in the classical point of Mc Burney, that is drawing an imaginary line between the umbilicus and the iliac spine, the midpoint, it evokes pain, especially when the hand of ' operator is suddenly raised, namely "pain relief" Blumberg sign positive.

Signs of peritoneal irritation, with the contraction of the abdominal wall mirror, clear or simple defense that goes if you persist in touch

Digital rectal examination, in turn, evokes pelvic pain associated with pelvic pain. The cable of Douglas can be explored in humans with digital rectal examination in men and women with the vaginal and evoke pain if there essudatizio liquid inside, the expression of inflammation.

The doctor will then require a CBC, which will highlight a neutrophilic leukocytosis and PCR to be high expression of nonspecific inflammation.

Evolution of appenidicite.

The attack may regress at best, perhaps by implementing an empirical antibiotic therapy, broad spectrum, but the patient may present new recurrence, or the attack of appendicitis may progress and intervene in this case the peritoneal barrier, which seeks to define the outbreak, since the evolution towards the framework of the "plastron". The latter can evolve again towards the framework dell'ascesso appendix, with the risk of peritoneal perforation, shock, fever, leukocytosis, and ashen facies exitus if nothing is done. It may well be, however, that does not happen and that inflammation and infection extends to the whole peritoneum (peritonitis), with dramatic picture, within 24-48 hours, I ave closed and gas, frequent pulse , dehydration, abdominal untreatable (abdomen surgery) and pain that extends beyond the midline.

Clinical forms

Appendicular peritonitis primitive, that is evolving in appendicitis peritonitis

Purulent peritonitis primitive

Putrid peritonitis due to perforation of gangrenous appendix

For home

Cecal appendix back, with pain in the iliac and lumbar shape this evolving towards the abscess.

· Pelvic appendix, which can mimic the signs of cystitis (see urine infections, urine infections Part I, Part II

Mesoceliaca appendicitis, with the tip located in Appendix abdominal cavity between the loops of the small intestine.

Appendicitis underepatic
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>>>see also RICERCA