Acute appendicitis (குடல்வால் அழற்சி )

Acute appendicitis :  Expect your diagnosis to be wrong about 50% of the time. This means that those who seen no to have appendicitis should be constantly re-examined.

Symptoms :  As the inflammatory process begins the patient feels a colicky pain referred to the central part of the abdomen. Once the peritoneum becomes involved with the inflammatory process the pain shifts to the right iliac fossa  and it may be accompanied by diarrhoea and vomiting.

    Fever                          Lying still                              RIF signs

    Tachycardia               Flushed                                  Tenderness,guarding

    Furred tongue            Coughing hurts                      Rebound tenderness

                                       Shallow breaths                     PR painful on right

Special Tests include Rovsigng's sign which is pain more in the RIF than the LIF when the LIF is pressed. Indirect rebound tenderness may also be felt in the RIF after pressure is released in the LIF.

With the obturator test the hip is flexed and internally rotated. If this produces more pain when it is the right hip that is flexed, it is a sign of a deep-lying inflamed appendix irritating the obturator muscle.

   If the child is anxious, use his hand to press his belly. Do not rely on tests such as WCC or urinoscopy.

  Perforated ulcer                   Cholecystitis                       Mesenteric adenitis

  Food poisoning                   Diverticulitis                        Salpingitis

                                              Cystitis                                Crohn's

Treatment :  Early appendicectomy. Metronidazole suppositories 1g/8h, three doses PR starting 1 h pre-operatively, reduces wound infections (eg.,from 24% to 12% in one study).

   Perforation leading to peritonitis; formation of an appendix mass (inflamed appendix surrounded by omentum): appendix abscess.