Appendicitis

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Appendicitis is responsible for 1% of all surgical procedures, though the incidence is falling. The incidence is lowest in infants and the elderly, and highest in teens and twenties. Appendicitis may be infective or obstructive, and usually presents with peri-umbilical pain localizing to right lower quadrant of the abdomen – the so-called McBurney's point. Symptoms may be accompanied by anorexia, nausea, vomiting, fever and diarrhea.

Patients usually present with tenderness in the right lower quadrant of the abdomen with guarding and rebound tenderness, Rovsing sign, Psoas sign, tenderness in the pelvis on rectal exam, fever and tachycardia.

Investigative tests include a complete blood count (CBC), plain x-ray of the abdomen (which would reveal a fecolith, ultrasound and computerized tomography (CT) scan. Potential complications include gangrene, perforation, and abscess formation.

Appendicitis in infants is difficult to diagnose due to the high perforation rate. Appendicitis during pregnancy of the reproductive female usually present atypically, and so a high index of suspicion is necessary. When in doubt, one should always operate first and ask questions later. Symptoms of appendicitis in the elderly may be masked, and the perforation rate is high.

The gold standard of treatment for appendicitis is an appendectomy, which is to say the removal of the appendix. If shit isn't good, percutaneous drainage for the abscess can happen first, followed by a delayed interval appendectomy.


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