APPENDICITIS 3 symptoms

 CLINICAL MANIFESTATIONS SYMPTOMS

3.1  Absominal  pain  as outlined above is  the  main  presenting

symptom. The other common  causes  of pain  abdomen  are shown in

Fig 20.1

In  typical  cases the pain is diffuse and central  abdominal  in

situation  (around the umbilicus) and is moderately severe  (Fig.

20.1a).

                                       BOX

*  There  may be  superadded           FEATURE OF ACUTE APPENDICITIS

   colicky pain

                                       * Abdominal pain for less than

*  After a varying period of             72 hours

   upto  twelve  hours   the           * Vomiting one to three times

   pain is localized in  the           * Facial flush

   right iliac fossa.                  * Tenderness concentrated on the

                                         right iliac fossa

*  There    may   be    some           * Anterior tenderness on rectal

   variation in the site  of             examination

   pain because of different           * Fever between 37.3 and 38.5

   anatomic location of  the             degree C

   appendix.                           * No evidence of urinary tract

                                         infection on urine

*  Anorexia and vomiting are             microscopy

   present in two thirds  of

   the patients.                                     

*  There  is accompanying constipation, though in  some  patients,

   there may be diarrhoea.

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APPENDICITIS 2 Pathology

2. PATHOLOGY

The  most important factor in the causation of this  disorder  is

obstruction  of  the  lumen either by  a  feacolith  or  lymphoid

hypertrophy in the wall of the appendix.

Vegetable matter and intestinal worms can also be responsible for

obstruction of the lumen.

The  obstruction  causes  a  closed  loop,  obstructions  of  the

isolated appendix lumen leading to :

Sequence

-  Collection  of   secretions   within  its  lumen  causing   in

   distension     which stimulates the nerve endings  and  causes

   dull visceral pain.

-  There  is  stasis  and  multiplication  of  bacteria   causing

   inflamatory  response  further distension as also  release  of

   exotoxins.

-  Stimulation of peristalsis causing a colicky pain.

-  Stagnation  of  contents leads to  further  multiplication  of

   bacteria which are resident there.

-  Further  increase  in  the pressure within the  lumen  of  the

   appendix.

-  Pressure  within  the  lumen obstructs  the  veins  and  later

   arteries of the appendix and interferes with the blood supply.

-  Necrosis  and  gangrene of the gangrene of the  appendix  with

   resultant spreading peritonitis.

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Appendicitis 1 occurrence

APPENDICITIS

1. OCCURANCE

A  sudden  acute inflamation of the appendix is  common  surgical

emergency in developed countries it occurs in about 200 people in

1,00,000 population. In developing countries it is less common.

The vermiform appendix is located in the right iliac fossa and is

attached to the cecum.  It is from 6 to 10 cm in length.  It  has

a  mesoappendix  with  appendicular artery running  in  its  free

border.   The  lumen is lined with mucosa of the similar  to  the

colon  rich in lymph follicles.   The long axis of  the  appendix

may  lie in any position in a clockwise rotation.  This  position

results  in the varied site gaurding and tenderness in  cases  of

appendicitis.

Acute appendicitis is a common acute surgical diagnosis in India.

It can occur at any age, the largest number of cases occur in the

2nd and 3rd decades of life.

The disease occurs in males and females with equal frequency.

Death  can occur if the disease spreads beyond the  appendix  and

causes peritonitis.

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PILONIDAL SINUS

PILONIDAL SINUS

This  term is applied to any inflamed subcutaneous  tissue  which

contains  hair.   This type of sinus is found most often  in  the

cleft  between  the buttocks.  It can also occur in webs  of  the

fingers  and umbilicus.  These are repeated attacks of  infection

and  abscess  formation  and a chronic  discharging  sinus.   The

cavity is lined with epithelium and granulation.

TREATMENT

An  acute  inflammation  needs  to be  drained  and  followed  by

dressings. 

A  chronic  small sinus can be treated conservatively  with  sitz

bath cleaning and dressing.

A  discharging sinus with long history will need  wide  excision. 

The  excised  tissue  includes the sinus's , the  tract  and  the

inflammed area containing the hair.

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