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DIAGNOSIS

APENDISITIS

Dr Donald Aronggear SpB FINACS


SMF Bedah RSUD Jayapura Papua
2007
Epidemiologi
7% penduduk US
1,1 per 1000 penduduk per tahun
Laki-laki : perempuan = 1,4 : 1
Mortality rate 0,2-0,8%
Mortality rate pada usia > 70 th = 20%
Perforasi paling tinggi umur < 18 th dan >50
th
USA 250.000 apendektomi/tahun
Anatomi
ACUTE APPENDICSITIS

Predisposing factor : - low fiber’s diet


Causative factor : - obstruction
- infection
Obstructive agents : - in the lumen of the appendix:
- fecalith
- corpus aleinum
- parasite
Infective agents : - intra lumenar origin
- haematogenous origin
Pathology
Obstruction of the lumen
Mucous retention
Distension (increase intraluminar pressure)
Lymph and venous occlusion
Mucosal and sub mucosal oedema
Bacterial translokation
Inflammation / suppuration
Pus enter the lumen
Over distension
Arteriak occlusion
Pressure necrosis / gangrene

perforation
Progression of disease

- Gangrenous
- Perforation : - general peritonitis
- peri appendicular mass:
- phlegmoon / infiltrate
- absces
- sepsis
Symtoms
- abdominal pain: - visceral
- somatic
- anorectia, nausea, vomiting
- obstipation
- Others: - dysuria
- leucorrhoea
Signs
- Tenderness on the rigth iliac fossa
(specifically on Mc Bourney point)
- Rebound tenderness
- Muscular guarding (locally)
- Rectal examination : pain in the right
- sometimes : - right rectal rigidity
- hypersensitive on the sherens
triangle
Signs

Rovsing’s sign
Psoas’s sign
Obsturator’s sign
Tern Horn sign
Psoas sign
Obturator sign
TANDA & GEJALA
TANDA & GEJALA
Laboratory finding

- Leucocytosis (more than 10. 000/cm2


- Diff. Tell : shift to the left (neutrofilia)
- Urinalisa
- PP Test
- CRP
Differential Diagnosis
1. G.I Tract.
- mesenteric lymphadenitis
- peptic ulcer perforation
- acute cholecystitis
- diverticulitis : - jejunal
- ileal (Meckel)
- colonic
- ileitis terminalis
- tumor of the cecum
2. Urinary tract.
- rigth ureteric colic
- urinary tract infection
3. Gynaecologic disease.
- ruptured ectopic pregnancy
- twisted / torsion ovarian cyste
- ruptured ovarian cyste
- adnexitis
4. Non specific abdominal pain
Treatment
Acute appendicsitis : appendectomy
Negative pathology : 15 – 20 %
perappendicular mass : - conservative treatment :
- bed rest (fowler position)
- liquid diet
- antibiotic
if resolution : appendectomy a froid
if deteriorate : laparatomy & appendectomy
Radical treatment : laparatomy & appendectomy
General peritonitis : laparatomy & appendectomy
Antibiotic : for gram positive , gram negative
and anaerobe microganisme
Regimen : - ampicilin, gentamycin and
metronidazol
- seftriaxon and metronidazol
CHRONIC APPENDICITIS

- Chronic abdominal pain in the rigth iliac


fossa, but not severe
- Continue or intermittent
- sometimes gastritis like symptoms
- The lumen of the appendix not totally
obstructed
- Appendicogram : - non filling
- partial filling
- filling defect
Ultrasonogram showing longitudinal section (arrows) of

inflamed appendix.
laparoskopi