- Condition characterized by inflammation of the appendix.

BASIC TYPES
Chronic Appendicitis - Usually refers to a milder form of the illness and almost unperceivable symptoms this may include inflammation of the vermiform appendix with recurring attacks of right-sided abdominal pain over an extended period of time. Acute Appendicitis - Refers to complete obstruction of the vermiform appendix.

I. Signs and Symptoms

- Initially, some pain can be felt anywhere in the stomach area, but later, as it intensifies, its location becomes more defined in the lower right-hand side of the abdomen - an area known as McBurney point.

Progressively worsening pain Coughing or sneezing is painful Nausea Vomiting Diarrhea Inability to pass gas (break wind, fart) Fever Constipation Loss of appetite

II. Causes
Infection - a stomach infection may have found its way to the appendix. Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool may then have infected the appendix.

- Causative agents include : > Foreign bodies > Trauma > Intestinal worms > Lymphadenitis > Most commonly, calcified fecal deposits known as appendicoliths or fecaliths

III. Diagnosis
1. Typical appendicitis - Usually includes abdominal pain beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. - The pain then "settles" into the right lower quadrant (or the left lower quadrant in patients with situs inversus totalis), where tenderness develops. - The combination of pain, anorexia, leukocytosis, and fever is classic.

2. Atypical appendicitis - Lack the typical progression - May include pain in the right lower quadrant as an initial symptom. - Often require imaging with ultrasound and/or CT scanning

Aure-Rozanova sign - Increased pain on palpation with finger in right Petit triangle (can be a positive Shchetkin-Bloomberg's sign) - Also referred as rebound tenderness. Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the pressure causes the severe pain on the site indicating positive Blumberg's sign and peritonitis. Bartomier-Michelson's sign - Increased pain on palpation at the right iliac region as patient lies on his/her left side compared to when patient was on supine position. Dunphy's sign - Increased pain in the right lower quadrant with coughing. Kocher's (Kosher's) sign - From the history given, the appearance of pain in the epigastric region or around the stomach at the beginning of disease with a subsequent shift to the right iliac region.

Massouh sign - This sign, developed in and popular in southwest England, describes a firm swish of the examiners index and middle finger across the patients abdomen from xiphoid sternum to first the left and then the right iliac fossa. - A positive Massouh sign is a grimace of the patient upon a right sided (and not left) sweep, because initial stage appendicitis usually causes localised irritation of the well-innervated peritoneum.
Obturator sign - If an inflamed appendix is in contact with the obturator internus, spasm of the muscle (called the obturator sign) can be demonstrated by flexing and internal rotation of the hip. - This maneuver will cause pain in the hypogastrium.

Psoas sign - or "Obraztsova's sign" is right lower-quadrant pain that is produced with either the passive extension of the patient's right hip (patient lying on left side, with knee in flexion) or by the patient's active flexion of the right hip while supine. - The pain elicited is due to inflammation of the peritoneum overlying the iliopsoas muscles and inflammation of the psoas muscles themselves. - Straightening out the leg causes pain because it stretches these muscles, while flexing the hip activates the iliopsoas and therefore also causes pain. Rovsing's sign - Continuous deep palpation starting from the left iliac fossa upwards (counterclockwise along the colon) may cause pain in the right iliac fossa, by pushing bowel contents towards the ileocaecal valve and thus increasing pressure around the appendix.

Sitkovskiy (Rosenstein)'s sign - Increased pain in the right iliac region as patient lies on his/her left side.

1. Blood and urine test 2. Imaging XRay Ultrasound Computed tomography

IV. Management
1. Pain - Pain medications (such as morphine) do not appear to affect the accuracy of the clinical diagnosis of appendicitis and therefore should be given early in the persons care. 2. Surgery Laparotomy - Consists in the removal of the infected appendix through a single larger incision in the lower right area of the abdomen. - The incision in a laparotomy is usually 2 to 3 inches (51 to 76 mm) long. - This type of surgery is used also for visualizing and examining structures inside the abdominal cavity and it is called exploratory laparotomy. Laparospic surgery - Consists of making three to four incisions in the abdomen, each 0.25 to 0.5 inches (6.4 to 13 mm) long. - This type of appendectomy is made by inserting a special surgical tool called laparoscope into one of the incisions. - The laparoscope is connected to a monitor outside the patient's body and it is designed to help the surgeon to inspect the infected area in the abdomen.

V. Prognosis
- Most appendicitis patients recover easily with surgical treatment, but complications can occur if treatment is delayed or if peritonitis occurs.