ACUTE APPENDICITIS (PATHOLOGY )

 

Acute appendicitis 

 

It is non- specific inflammation of the appendix.

Pathological form of acute appendicitis

ü Simple form : appendix is slightly tense, its serosa is hyperemic and edematous.

Lumen –odourless serous fluid

Microscopically-mucosal edema, single erosions

ü Phlegm nous form: thickened appendix, tense, hyperemic, covered with fibrin, abdomen lumen filled with pus.

Microscopically – leukocytes infiltration of the appendix tissue purulent destruction of its walls.

ü Gangrenous form: necrosis in wall perforated walls

Lumen –necrotic debritus

Microscopically- thrombosis of the vessels of the abdomen, necrotic change in its walls.

 

Provisional diagnosis

 

Questioning

Complaints: pain in the right iliac region, without irradiation, delayed defecations, low grade fever.

Anamnesis morbi: acute onset, pain occurs in healthy state of patient, pain occurs without provoking factors, epigastric pain, epigastric pain, diffuse pain through the abdomen which shift in the right iliac region(volkovych-kocher’s sign).

Anamnesis vitae: constipation, bad bowel movements, blockage in the lining of the appendix, streptococcal infection, inflammatory bowel disease, ruptures of walls of the appendix.

Physical examination

Visual examination: abdomen is asymmetrical, right iliac region not participate in breathing.

Palpation: superficial palpation-muscle tension and tenderness in the right iliac region.

Deep palpation- increased tenderness in right iliac region.

Percussion : rebound tenderness, pain on percussion, rigidity

Auscultation: bowel sound present but hypoactive.

 

Pathological signs 

Bartomier-Mikhelson’s- pain increases as palpation at the right iliac region as the person being examined lies on left side.

-Rovsing’s sign – if palpation of the left lower quadrant of a person’s abdomen increases the pain felt in right lower quadrant, the patient may have appendicitis.

- Obratsow’s sign –it indicates irritation to the iliopsoas group of hip flexors in the abdomen and consequently indicates that the inflamed appendix is retrocaecal in orientation.

Other two signs are Razdolsky’s sign, voskresensky’s sign.

Complications of appendicitis

·     Sudden pain that begins on the right side of the lower abdomen

·     Nausea and vomiting

·     Abdominal bloating

·     Loss of appetite

·     Constipation or diarrhea

·     Low grade fever that any worsen as the illness progresses

·     Ruptured appendix

·     Pocket of pus that forms in the abdomen

 

 

Differential diagnosis: acute cholecystitis, duodenal ulcer complicated by perforation; gynecological- ectopic pregnancy

 

Laboratory instrumental methods

Complete blood count(leukocyte left shift

 segmented neutrophil increase 

urine analysis In urinalysis up to 40% of can have abnormalities

fresh erythrocytes found

 

Treatment

Surgery and therapeutic (antibiotics, pain relievers 

 I.V fluid 

 liquid diet’ needle drainage from abscess

                                                                       -by Dr. Ravi Ranjan