Acute Appendisitis

DIAGNOSIS APENDISITISDr Donald Aronggear SpBSMF Bedah RSUD Jayapura Papua2007

Epidemiologi7% penduduk US1,1 per 1000 penduduk per tahunLaki-laki : perempuan = 1,4 : 1Mortality rate 0,2-0,8%Mortality rate pada usia > 70 th = 20%Perforasi paling tinggi umur < 18 th dan >50 thUSA 250.000 apendektomi/tahun

Anatomi

ACUTE APPENDICSITISPredisposing factor: - low fibers dietCausative factor: - obstruction - infectionObstructive agents: - in the lumen of the appendix:- fecalith- corpus aleinum- parasiteInfective agents: - intra lumenar origin - haematogenous origin

PathologyObstruction of the lumenMucous retentionDistension (increase intraluminar pressure)Lymph and venous occlusionMucosal and sub mucosal oedemaBacterial translokationInflammation / suppurationPus enter the lumenOver distensionArteriak occlusionPressure necrosis / gangrene

perforation

Progression of disease

- Gangrenous- Perforation : - general peritonitis - peri appendicular mass: - phlegmoon / infiltrate - absces - sepsis

Symtoms- abdominal pain: - visceral - somatic- anorectia, nausea, vomiting- obstipation- Others: - dysuria - leucorrhoea

- Tenderness on the rigth iliac fossa (specifically on Mc Bourney point) - Rebound tenderness- Muscular guarding (locally)- Rectal examination : pain in the right- sometimes : - right rectal rigidity - hypersensitive on the sherens triangleSigns

Rovsings signPsoass signObsturators signTern Horn sign

Signs

Psoas sign

Obturator sign

TANDA & GEJALA

TANDA & GEJALA

Laboratory finding Leucocytosis (more than 10. 000/cm2 - Diff. Tell : shift to the left (neutrofilia) Urinalisa PP Test CRP

Differential Diagnosis1. G.I Tract.- mesenteric lymphadenitis- peptic ulcer perforation- acute cholecystitis- diverticulitis : - jejunal - ileal (Meckel) - colonic- ileitis terminalis - tumor of the cecum

2. Urinary tract.- rigth ureteric colic- urinary tract infection3. Gynaecologic disease.- ruptured ectopic pregnancy - twisted / torsion ovarian cyste- ruptured ovarian cyste- adnexitis4. Non specific abdominal pain

TreatmentAcute appendicsitis: appendectomyNegative pathology: 15 20 %perappendicular mass: - conservative treatment : - bed rest (fowler position) - liquid diet - antibioticif resolution: appendectomy a froidif deteriorate: laparatomy & appendectomyRadical treatment: laparatomy & appendectomyGeneral peritonitis: laparatomy & appendectomy

Antibiotic : for gram positive , gram negative and anaerobe microganismeRegimen : - ampicilin, gentamycin and metronidazol - seftriaxon and metronidazol

Chronic abdominal pain in the rigth iliac fossa, but not severe - Continue or intermittent- sometimes gastritis like symptoms- The lumen of the appendix not totally obstructed- Appendicogram : - non filling - partial filling - filling defectCHRONIC APPENDICITIS

Ultrasonogram showing longitudinal section (arrows) of inflamed appendix.

laparoskopi