Appendicitis
Appendicitis is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Most common abdominal emergency
- Acute obstruction of appendiceal lumen results in distension followed by organ ischemia, bacterial overgrowth, and eventual perforation of the viscus
- Pain migration:
- Periumbilical pain: Appendiceal distension stimulates stretch receptors, which relay pain via visceral afferent pain fibers to 10th thoracic ganglion.
- RLQ pain: As inflammation extends to surrounding tissues, pain occurs owing to stimulation of parietal nerve fibers and localizes to position of appendix.
Pediatric Considerations
- 28–57% misdiagnosis in patients <12 yr (nearly 100% in patients <2 yr)
- 70–90% perforation rate in children <4 yr
- Perforation correlates strongly with delayed diagnosis.
Geriatric Considerations
- Decreased inflammatory response
- 3 times more likely to have perforation owing to anatomic changes
- Diagnosis often delayed owing to atypical presentations
Pregnancy Considerations
- Slightly higher rate in 2nd trimester compared to 1st/3rd/postpartum periods
- Increased perforation rate (25–40%), highest in 3rd trimester
- RLQ pain remains the most common symptom
- 7–10% fetal loss, up to 24% in perforated appendicitis
Etiology
Etiology
- Luminal obstruction of appendix
- Appendiceal lumen becomes distended, inhibiting lymphatic and venous drainage.
- Bacterial invasion of wall, with edema and blockage of arterial blood flow
- Perforation and spillage of contents into peritoneal cavity, causing peritonitis (usually 24–36 hr from onset)
- May wall off and form abscess
- Gram-negative rods and anaerobic organisms predominate
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Citation
Rosen, Peter, et al., editors. "Appendicitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/1.3/Appendicitis.
Appendicitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/1.3/Appendicitis. Accessed December 5, 2019.
Appendicitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/1.3/Appendicitis
Appendicitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/1.3/Appendicitis.
* Article titles in AMA citation format should be in sentence-case
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