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INTRODUCTION
The appendix is :
Catarrhal appendicitis.
-lymphoid hyperplasia (60% children)
-Gastro enteritis
-Virus
-Acute respiratory infection
-Mononucleosis
Obstructive appendicitis
-fecalith 35% adults.
- tumors (1%)
Patofisiologi
Pathophysiology
Wangensteen proposed
1. Closed loop obstruction
2. Increase in luminal pressure.
3. Exceeds capillary pressure causes mucosal ischemia
4. Luminal bacterial overgrowth and translocation bacteria across the appendiceal wall
result :
-Inflammation
-Edema
-Necrosis perforation occur about 48 hours .
If the body successfully walls off the perforation Appendiceal Mass
If the perforation is not successfully walled off Diffuse peritonitis will develop.
Problem:
Laboratory test
Imaging investigation
Statistics report
1 of 5 cases is misdiagnosed
Urinalysis
•Lying down
McBurney's point
it is only the area
of greatest tenderness
Blumberg sign
Rovsing’s Sign
Obturator sign
Psoas sign
Markle sign
Location appendix during pregnancy
INDICATIONS
A = Anorexia 1
T = Tenderness in RLQ 2
R = Rebound pain 1
E = Elevated temperature 1
L = Leukocytosis 2
Total 10
1. Noninvasiveness,
2. Short acquisition time
3. Lack of radiation exposure
4. Potential for diagnosis of other causes
of abdominal pain
5. Pediatric patients
6. Women of childbearing age.
7. Pregnant women
CT scan more than 6 mm
USG / CT scan
-May improve diagnostic accuracy
2. Laparoscopic appendectomy
- Meckel's diverticulum
- Acute salpingitis
- Crohn's disease
If the body successfully walls off the localized perforation
Appendiceal Mass
RLQ mass
The pain may actually improve.
Symptoms do not completely resolve.
Still have right lower quadrant pain
Decreased appetite
Change in bowel habits (eg, diarrhea, constipation)
Intermittent low-grade fever.
Treatment of
Appendiceal Mass
Nonoperative management
Becomes walled off by omentum and ajacent viscera.
Initially treated with intravenous broad-spectrum antibiotic
Perkusi : Timpani
Auskultasi : Peristaltik (+) lemah
Perkusi : Timpani
Auskultasi : Peristaltik (+) lemah
Perkusi : Timpani
Auskultasi : Peristaltik (+) lemah
Diagnosis
a.Anamnesis
- Nyeri periumbilikal yang akan - Nyeri dirasakan di seluruh perut
berpindah ke kuadran kananbawah - Mual dan muntah(+)
- Anoreksia - Demam tidak terlalu tinggi(+)
- Mual danmuntah - Konstipasi (+)
- Demam tak terlalutinggi
- Konstipasi
- Diare
- Malaise
b. Pemeriksaan fisik Pada pemeriksaan abdomen
Distensi perut dijumpai :
Nyeri tekan dan nyeri lepas - Bising usus menurun (+)
Bising usus menurun/menghilang