Management of acute appendicitis

Diagnosis is clinical. Alvarado score is used to diagnose clinically. Score Symptoms Migrating RIF pain Anorexia Nausea, vomiting 1 1 1

Signs

Tenderness (RIF) 2 Rebound tenderness 1 Elevated temperature 1 Leukocytosis Shift to left 1 1

Lab

Score of 7 or more is strongly predictive of acute appendicitis.

Investigations Routine investigations Full blood count Urinalysis Selective investigations Pregnancy test Urea and electrolytes Supine abdomen X ray US scan of pelvis Contrast CT abdomen

Treatment Non operative treatment Keep the patient in semi upright position. Give fluids only, by mouth or intravenously. Monitor pulse rate 4 hourly and tepperature twice daily.

Natural history of acute appendicitis Resolution (80%) Deterioration (10%) Abscess formation No change

Operative treatment Appendicectomy

Pre operative preparation 1. Intra venous fluids to establish adequate urine output. 2. Antiobiotics to cover gram negative bacilli and anaerobes. 3. Hyperpyrexia in children should be treated with salicylates.

Post operative complications 1. 2. 3. 4. 5. 6. 7. 8. Wound infection most common. Around 4th or 5th post op day. Intra abdominal abscess. Ileus. Respiratory complications. Venous thrombosis and embolism. Portal pyaema Faecal fistula. Adhesive intestinal obstruction.

Complications of appendicitis 1. Perforation 2. Appendicular mass ( covering off of perforation by omentum, bowel) 3. Appendicular abscess (suppuration)

Management of appendicular mass Conservative Ochsner Sherren regimen Careful recording of patients condition and extent of mass (mark with a pencil) Give antibiotics Do CT scan Drain the abscess radiologically Monitor pulse rate, temperature, input output Clinical evidence of peritonitis indicates early laparotomy Interval appendicectomy is not recommended