1. 急性闌尾炎 Acute appendicitis

2. PATHOPHYSIOLOGY Lumen obstruction Necrosis, Luminal pressure↑
Perforation
Fecalith, lymphoid follicles
Bacterial growth,
Venous obstruction
Arterial compromised

3. History Periumbilical or epigastric pain Right lower quadrant pain
Lumen obstruction → Visceral pain
Anorexia (90%), nausea & vomiting (70%), diarrhea (10%)
Right lower quadrant pain
Transmural inflammation → Parietal pain
Peritoneal irritation, pain on movement, fever, tachycardia
Diffused tenderness
Ruptured appendicitis with peritonitis

4. Physical examination McBurney’s point tenderness Rovsing’s sign
RLQ pain resulting from palpation in the left lower quadrant

5. Lab & Radiologic exam Lab Radiologic exam CBC U/A
Electrolytes, BUN, creatinine
Pregnancy test
Radiologic exam
X-ray: rarely helpful
Ultrasound: operator dependent
CT scan: most common, sensitivity 94%, specificity 95%
MRI: for pregnant patient

6. Alvarado Score for Acute Appendicitis (MANTRELS)
Abdominal pain that Migrates to the right iliac fossa (2pts)
Anorexia (loss of appetite) or ketones in the urine
Nausea or vomiting
Tenderness in the right iliac fossa
Rebound tenderness
Fever of 37.3 °C or more (Elevated temperature)
Leukocytosis, (>10000 WBC/mL) (2pts)
Neutrophilia, or Shift of neutrophils to the left
Total score
<5
Unlikely
5 or 6
Possible
7 or 8
Likely
9 or 10
Highly likely

7. Treatment Antibiotics therapy Appendectomy
Broad-spectrum gram-negative and anaerobic coverage
Appendectomy
Open appendectomy
Conventional procedure
Laparoscopic appendectomy
Reduce pain, hospital stay
Quicker return to work
Lower risk of wound infection
Benefit in obese and woman