Behind the Pain: Recognizing The Warning Signs Of Acute Appendicitis

Abstract

Acute appendicitis is a surgical emergency and one of the most common cause if acute abdominal pain. Appendicitis means inflammation of vermiform appendix. Common age group is 10 -20 years. Causes of appendicitis include obstruction of its lumen with fecolith, calculi, infection and lack of dietary fiber. Clinical presentation vary thus called chameleon of surgery .Typical feature include periumblical pain that migrates to right iliac fossa over the next 24 hours accompanied by nausea ,anorexia and vomiting. Typical features were first described by Murphy and are present in 50 percent of the cases.Atypical symptoms include diarrhea,constipation,urinary tract infection. Pregnant women feel pain in the upper abdomen due to displacement of appendix by uterus. It can be classified as un complicated which means inflammation with abscess formation and complicated that means appendix is inflammed along with abcess formation and peri appendiceal phelgmon.Clinical signs include elevated temprature and rebound tenderness. Physical examination includes a postive rovsing sign, obturator sign, obturator sign or psoas sign. Alvardo scoring system is one the few scoring systems used to diagnose a case of suspected appendicitis. Total score is 10.A score of 7-10 indicated surgical intervention. Among the imaging modalities usg abdomen is the first choice but CT abdomen is superior to it because of its increased sensitivity and specificity. Laproscopic appendectomy is most effective surgical intervention. Uncomplicated cases can be treated with piperacillin tazobactam. Complicated cases can be treated with combination antibiotics cephalosporin combined with flouroquinolones or metronidazole.