Appendicitis
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Basics
Description
- Most common abdominal emergency
- Most common indication for emergency surgery worldwide
- Acute obstruction of appendiceal lumen results in distension followed by ischemia, bacterial overgrowth, and eventual perforation of the viscus
- Classic pain migration:
- Periumbilical pain: Appendiceal distension stimulates stretch receptors, which relay pain via visceral afferent pain fibers to tenth 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)
- 60–86% perforation rate in children <4 yr
- Perforation correlates strongly with delayed diagnosis
Geriatric Considerations
- Decreased inflammatory response
- Up to 3 times more likely to have perforation owing to anatomic changes
- Diagnosis often delayed owing to atypical presentations
Pregnancy Considerations
- Slightly higher rate in second trimester compared to first/third/postpartum periods
- Increased perforation rate (25–40%), highest in third trimester
- RLQ pain remains the most common symptom
- 5–10% fetal loss, up to 24% in perforated appendicitis
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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Most common abdominal emergency
- Most common indication for emergency surgery worldwide
- Acute obstruction of appendiceal lumen results in distension followed by ischemia, bacterial overgrowth, and eventual perforation of the viscus
- Classic pain migration:
- Periumbilical pain: Appendiceal distension stimulates stretch receptors, which relay pain via visceral afferent pain fibers to tenth 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)
- 60–86% perforation rate in children <4 yr
- Perforation correlates strongly with delayed diagnosis
Geriatric Considerations
- Decreased inflammatory response
- Up to 3 times more likely to have perforation owing to anatomic changes
- Diagnosis often delayed owing to atypical presentations
Pregnancy Considerations
- Slightly higher rate in second trimester compared to first/third/postpartum periods
- Increased perforation rate (25–40%), highest in third trimester
- RLQ pain remains the most common symptom
- 5–10% fetal loss, up to 24% in perforated appendicitis
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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