APPENDICITIS

 

Clinical Features

1. Start classically with diffuse abdominal pain felt most prominently in the peritoeumblical area.
2. There is anorexia and nausea. Vomiting may follow.
3. Pain then settles in the right lower quadrant and is localized at McBurney’s point. The pain may be relieved briefly after perforation but is accentuated by ensuring diffuse peritonitis.
4. There is localized tenderness in the right lower quadrant, rebound tenderness,muscle guarding, cutaneous hyperaesthesia, and pelvic tenderness.in the  right iliac fossa on rectal examination. Rovsing’s sign may be positive and temperature may be elevated.

Investigations

Laboratory examinations are not critical for diagnosis. There is leukocytosis with neutrophilia. Normal values do not rule out appendicitis, however.

Management

1. Initiate appropriate resuscitation.
2. Once diagnosis is made, give analgesics whilst preparing for surgery.
3. Starve the patient before surgery.
4. Give premedication when there is time(atropine 0.6mg IM and morphine 10 mg IM stat).
5. Appendicectomy is the treatment of choice, once a definitive diagnosis is made.