Appendicitis

Definisi
Etiologi
Gejala klinis
Nyeri pada umbilikus dan berpindah ke kuadran kanan bawah
abdomen
Mual / muntah
Demam
Pemeriksaan fisik
In a minority of patients with acute appendicitis, some other signs may be noted.
However, their absence never should be used to rule out appendiceal inflammation. The
Rovsing sign (RLQ pain with palpation of the LLQ) suggests peritoneal irritation in the RLQ
precipitated by palpation at a remote location. The obturator sign (RLQ pain with internal
and external rotation of the flexed right hip) suggests that the inflamed appendix is
located deep in the right hemipelvis. The psoas sign (RLQ pain with extension of the right
hip or with flexion of the right hip against resistance) suggests that an inflamed appendix
is located along the course of the right psoas muscle.
The Dunphy sign (sharp pain in the RLQ elicited by a voluntary cough) may be helpful in
making the clinical diagnosis of localized peritonitis. Similarly, RLQ pain in response to
percussion of a remote quadrant of the abdomen, or to firm percussion of the patient's
heel, suggests peritoneal inflammation.
The Markle sign, pain elicited in a certain area of the abdomen when the standing
patient drops from standing on toes to the heels with a jarring landing, was studied in
190 patients undergoing appendectomy and found to have a sensitivity of 74%
Rectal examination
Stages of Appendicitis
The stages of appendicitis can be divided into early, suppurative, gangrenous, perforated, phlegmonous,
spontaneous resolving, recurrent, and chronic.
Early stage appendicitis
In the early stage of appendicitis, obstruction of the appendiceal lumen leads to mucosal edema, mucosal
ulceration, bacterial diapedesis, appendiceal distention due to accumulated fluid, and increasing
intraluminal pressure. The visceral afferent nerve fibers are stimulated, and the patient perceives mild
visceral periumbilical or epigastric pain, which usually lasts 4-6 hours.
Suppurative appendicitis
Increasing intraluminal pressures eventually exceed capillary perfusion pressure, which is associated with
obstructed lymphatic and venous drainage and allows bacterial and inflammatory fluid invasion of the tense
appendiceal wall. Transmural spread of bacteria causes acute suppurative appendicitis. When the inflamed
serosa of the appendix comes in contact with the parietal peritoneum, patients typically experience the
classic shift of pain from the periumbilicus to the right lower abdominal quadrant (RLQ), which is continuous
and more severe than the early visceral pain.
Gangrenous appendicitis
Intramural venous and arterial thromboses ensue, resulting in gangrenous appendicitis.
Perforated appendicitis
 Persisting tissue ischemia results in appendiceal infarction and perforation. Perforation
can cause localized or generalized peritonitis.
Phlegmonous appendicitis or abscess
An inflamed or perforated appendix can be walled off by the adjacent greater omentum
or small-bowel loops, resulting in phlegmonous appendicitis or focal abscess.
Spontaneously resolving appendicitis
If the obstruction of the appendiceal lumen is relieved, acute appendicitis may resolve
spontaneously.[22, 23] This occurs if the cause of the symptoms is lymphoid hyperplasia or
when a fecalith is expelled from the lumen.
Recurrent appendicitis
The incidence of recurrent appendicitis is 10%. The diagnosis is accepted as such if the
patient underwent similar occurrences of RLQ pain at different times that, after
appendectomy, were histopathologically proven to be the result of an inflamed
appendix.
Chronic appendicitis
Chronic appendicitis occurs with an incidence of 1% and is defined by the following: (1)
the patient has a history of RLQ pain of at least 3 weeks duration without an alternative
diagnosis; (2) after appendectomy, the patient experiences complete relief of symptoms;
(3) histopathologically, the symptoms were proven to be the result of chronic active
inflammation of the appendiceal wall or fibrosis of the appendix.
Pemeriksaan penunjang