Professional Documents
Culture Documents
- these anatomic
considerations have
significant clinical importance
in the context of acute
appendicitis
E. Coli Bacteroides
fragilis Pseudomonas aeruginosa
Bacteroides species Klebsiella species
Fusobacterium species
Streptococcus anginosus
Peptostreptococcus species Streptococcus species
Gram-positive bacilli Enterococcus
species Clostridium species
Peritoneal culture should be reserved for patients who are
immunosuppressed, as a result of either illness or medication,
and for patients who develop an abscess after the treatment
of appendicitis.
obstipation
Diarrhea
Fever
Signs
usually prefer to lie supine, with the thighs, particularly the right
thigh, drawn up, because any motion increases pain. If asked
to move, they do so slowly and with caution.
Pararectal tenderness
Laboratory Findings
Barium enema
Manifestations Value
Symptoms Migration of pain 1
Anorexia 1
Nausea/vomiting 1
Rebound 1
Elevated temperature 1
Acute Gastroenteritis
Salmonella gastroenteritis (typhoid fever)
Meckel's Diverticulitis
Intussusception
Crohn's Enteritis
Differential Diagnosis
Colonic Lesions
Diverticulitis
perforating carcinoma of the cecum, or
sigmoid clinical presentations.
Epiploic Appendagitis
Ureteral Stone
Primary Peritonitis
Differential Diagnosis
Henoch-Schönlein Purpura
Campylobacter jejuni
Salmonella typhimurium
Gynecologic Disorders
pelvic inflammatory disease
ruptured graafian follicle
twisted ovarian cyst or tumor
endometriosis
ruptured ectopic pregnancy
Differential Diagnosis
Other Diseases
-
Morbidity rates parallel mortality rates, being significantly increased
by rupture of the appendix and to a lesser extent by old age
abscess
wound infection
intra-abdominal abscesses
Fecal fistula
Intestinal obstruction
inguinal hernia
Incisional hernia
Chronic Appendicitis
Amebiasis
-can also cause appendicitis.
-Invasion of the mucosa by trophozoites of Entamoeba histolytica
incites a marked inflammatory process
-Appendiceal involvement is a component of more generalized
intestinal amebiasis
- Appendectomy must be followed by appropriate antibiotic therapy
(metronidazole).
Incidental Appendectomy
Carcinoid
-firm, yellow, bulbar mass in the appendix should raise the
suspicion of an appendiceal carcinoid.
- appendix is the most common site of gastrointestinal
carcinoid, followed by the small bowel and then rectum.
Adenocarcinoma
-rare neoplasm of three major histologic subtypes: mucinous
adenocarcinoma, colonic adenocarcinoma, and
adenocarcinoid
-most common mode of presentation for appendiceal carcinoma is
that of acute appendicitis
- Patients may also present with ascites or a palpable mass, or the
neoplasm may be discovered during an operative procedure
for an unrelated cause.
- The recommended treatment for all patients with adenocarcinoma
of the appendix is a formal right hemicolectomy.
-Appendiceal adenocarcinomas have a propensity for early
perforation, although they are not clearly associated with a
worsened prognosis.
- Overall 5-year survival is 55% and varies with stage and grade.
Tumors
Mucocele
Pseudomyxoma Peritonei
Lymphoma
extremely uncommon
frequently involved extranodal site for non-Hodgkin's lymphoma.
frequency of primary lymphoma of the appendix ranges from 1 to
3% of gastrointestinal lymphomas
management of appendiceal lymphoma confined to the appendix is
appendectomy
Right hemicolectomy is indicated if there is extension of tumor
beyond the appendix onto the cecum or mesentery
postoperative staging workup is indicated prior to initiating
adjuvant therapy.
Adjuvant therapy is not indicated for lymphoma confined to
the appendix.
THANK YOU VERY MUCH
AND
GOOD MORNING