CONCLUSIONS: More than half of patients with ascending retrocecal appendicitis presented with atypical clinical presentation. [ncbi.nlm.nih.gov]

• Massive Splenomegaly

  Splenomegaly 387 C Laparoscopic Splenectomy 389 D MinimalAccess Open Splenectomy 392 E Preoperative Splenic Artery Embolization 399 F Conclusions 400 32 Insulinoma of Tail of Pancreas 405 C Laparoscopic Distal Pancreatectomy Without Splenectomy 406 D [books.google.com]

• Pediatric Disease

  Intussusception Intussusception is primarily a pediatric disease; however, it is estimated that between 5% and 16% of all intussusceptions in the Western world occur in adults, of which approximately two thirds of adult intussusception cases are caused [intranet.tdmu.edu.ua]

• Gastric Lavage

  Without having shown great attention to pregnancy of the patient when appendicitis demands special vigilance, the duty infectiologist of a reception undertook a number of risky medical actions — a gastric lavage and a cleansing enema. [infomeds.net]

• Decreased Breath Sounds

  His lungs were clear to auscultation except for decreased breath sounds over the right base, and there was a grade II-VI systolic ejection murmur along the left sternal border. [journals.lww.com]

• Abdominal Pain

  Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. [ncbi.nlm.nih.gov]

  Keywords: Computed tomography Retrocecal appendicitis Upper abdominal pain Issue Date: 2009 Citation: Ong, E.M.W., Venkatesh, S.K. (2009). Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography. [scholarbank.nus.edu.sg]

• Acute Abdomen

  Clinical science Physician Summary Appendicitis refers to acute inflammation of the appendix, and is the most common cause of acute abdomen requiring emergency surgery. [amboss.com]

  After the general surgery consultation with the diagnosis of acute abdomen, the patient underwent surgery immediately. Appendectomy was performed with the right paramedian incision. The stump was buried and mesoplasty was performed. [turkjsurg.com]

  It is diagnosed either after contrast enhanced computed tomography scan of abdomen or after diagnostic laparoscopy for acute abdomen. It is best to go for diagnostic laparoscopy in acute abdomen whenever there is diagnostic difficulty. References 1. [ispub.com]

  INTRODUCTION Appendicitis is a common cause of acute abdomen, with an expected lifetime occurrence of 7% and a mortality rate of less than 1% if the appendix is not perforated [1]. [academic.oup.com]

• Obturator Sign

  The obturator sign indicates the presence of an inflamed pelvic appendix. [en.wikipedia.org]

  sign raise the patient's right leg with the knee flexed rotate the leg internally at the hip increased abdominal pain indicates a positive obturator sign Rovsing's sign pressure over the descending colon causes pain in the RLQ Evaluation Labs absolute [medbullets.com]

  Anatomic basis for the obturator sign: inflamed appendix in the pelvis is in contact with the obturator internus muscle, which is stretched by this maneuver. [aafp.org]

  O bturator (Cope’s obturator) sign: Flexion and medial rotation at hip produces pain due to irritation of obturator muscle in pelvic appendicits. 5. [medchrome.com]

• Right Flank Pain

  A 3-year-old girl presented with high fever and right flank pain for more than 1 week. Ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system. [ncbi.nlm.nih.gov]

  Jul 28, 2009; 15(28): 3576-3579 Published online Jul 28, 2009. doi: 10.3748/wjg.15.3576 Figure 3 A 34-year-old man with colicky right flank pain and clinical diagnosis of right ureteric colic. [wjgnet.com]

  Two years later, she presented with fever, limping gait, and right flank pain. Ultrasound revealed fixed dilated bowel loops, a fecalith and a heterogeneous hypoechoic lesion (3.7 3.6 3.3 cm) at right psoas muscle, suspecting PA. [omicsonline.com]

• Right Lower Quadrant Tenderness

  Appendicitis in a patient with a retrocecal appendix may present atypically, with less or poorly localized pain, discomfort on coughing or walking, or flank, rather than right lower quadrant, tenderness. [acuteabd.weebly.com]

  Due to the location of the retrocecal appendix, right lower quadrant tenderness may not be observed. Therefore, there could be difficulties in the diagnosis (4). [turkjsurg.com]

  In 80% of cases, physical examination will reveal right lower- quadrant tenderness with guarding and rebound. Pain is localized at McBurney point, or 1.5-2 inches from the anterior superior iliac spine on a line from the spine to the umbilicus. [clinicaladvisor.com]

  The most important physical examination finding is right lower quadrant tenderness to palpation. [aafp.org]

• Murphy's Sign

  In this case, the cause of the right upper quadrant pain (presence of Murphy’s sign) was the irritation of the liver fascia. [turkjsurg.com]

  There was right hypochondrial tenderness with negative Murphy’s sign and renal punch. She had leukocytosis (13 200 cells/μL). A clinical diagnosis of acute cholecystitis was made. [ncbi.nlm.nih.gov]

• Ejection Murmur

  His lungs were clear to auscultation except for decreased breath sounds over the right base, and there was a grade II-VI systolic ejection murmur along the left sternal border. [journals.lww.com]

• Vaginal Discharge

  She also complained of foul-smelling urine and vaginal discharge. She had a termination of pregnancy 4 d earlier. The pain was increasing in severity and aggravated by movement and coughing. [ncbi.nlm.nih.gov]

• Pelvic Pain

  May present with profuse diarrhoea and pelvic pain. Retrocaecal appendix – 15% cases present in this way. Pain may localise to psoas muscle, the flank or right upper quadrant (5). [teachmepaediatrics.com]

  McBurney sign) pelvic pain, diarrhea and tenesmus (pelvic appendix) flank pain (retrocecal appendix) groin pain - appendix within an inguinal hernia (Amyand hernia) or a femoral hernia (De Garengeot hernia) right upper quadrant pain (subhepatic appendicitis [radiopaedia.org]

  In pelvic inflammatory disease, including salpingitis and tubo-ovarian abscess, there is a longer duration of symptoms, higher fever, greater leucocytosis and more pelvic pain. Gonococcal and chlamydial infection are the most common causes. [surgwiki.com]

  It is especially well suited in evaluating right lower quadrant or pelvic pain in pediatric and female patients. A normal appendix (6 mm or less in diameter) must be identified to rule out appendicitis. [aafp.org]

• Foul Smelling Urine

  She also complained of foul-smelling urine and vaginal discharge. She had a termination of pregnancy 4 d earlier. The pain was increasing in severity and aggravated by movement and coughing. [ncbi.nlm.nih.gov]

Most often, however a workup including lab tests and imaging is required. Workup Laboratory studies There is no single lab test specific for the diagnosis of appendicitis. [cdemcurriculum.com]

Before his extensive GI tract workup, he had undergone investigations to exclude cardiac, renal and liver disease. In addition, mucosal disease of the GI tract had been excluded. [ncbi.nlm.nih.gov]

• Pericardial Effusion

  Her hospital course was complicated with empyema, peritonitis, and pericardial effusion. A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission. [ncbi.nlm.nih.gov]

Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]

A combined treatment of ultrasound or CT-guided percutaneous drainage and systemic antibiotics for psoas abscess has been successfully recently and has become the preferred method for treatment [27]. [omicsonline.org]

Diagnosis and treatment of pylephlebitis or appendicular origin (in German). Vestnik Khir Im I I Grek 1989;142:25-8. 17. Ford RD, Passinault WJ, Morse ME. [journals.lww.com]

It has been 3 weeks after I finished treatment but still have discomfort and pain, specially if I walk, or move. Doctor said this is "normal" but I am starting to feel a little more pain than before. [ourhealth.com]

The patient was a case of ruptured appendicitis with successful conservative treatment. The patient missed the follow-up schedule for elective interval appendectomy. Two years later, she presented with fever, limping gait, and right flank pain. [omicsonline.com]

Prognosis Special patient groups Appendicitis in pregnancy Children, the elderly, and pregnant women are at higher risk of perforation! [amboss.com]

Prognosis Most appendicitis patients recover easily with treatment, but complications can occur if treatment is delayed or if peritonitis occurs secondary to a perforated appendix. [academickids.com]

PID, ovarian torsion, gyn disorders, volvulus, gastroenteritis, ectopic pregnancy, pyelonephritis, diverticulits, colorectal cancer, IBD, cholecystitis, Meckel's, mesenteric ischemia Treatment Laparoscopic Appendectomy CT guided drainage of abscess Prognosis [medbullets.com]

Treatment and prognosis The mainstay of treatment is supportive, as the disease is typically self-limiting. If severe or protracted medical therapy with corticosteroids, cyclophosphamide or azathioprine can be contemplated 2. [radiopaedia.org]

Leu SY, Leonard MB, Beart RW Jr, Dozois RR (1986) Psoas abscess: Changing patterns of diagnosis and etiology. Dis Colon Rectum 29: 694-698. Procaccino JA, Lavery IC, Fazio VW, Oakley JR (1991) Psoas abscess: difficulties encountered. [omicsonline.org]

Etiology Pathophysiology Clinical features Nonspecific symptoms Progressive fever Anorexia (hamburger sign ) Nausea, vomiting, diarrhea;, and/or constipation Abdominal pain: classical presentation Initially, dull migratory periumbilical pain (due to visceral [amboss.com]

If left lower quadrant pressure by the examiner leads only to left-sided pain or pain on both the left and right sides, then there may be some other pathologic etiology. [en.wikipedia.org]

Introduction Increased frequency 10-30 years of age More common in US due to low fiber diet Most common etiologies are lymphoid hyperplasia fecolith obstruction Presentation Symptoms loss of appetite, nausea, vomiting fever pain moves from periumbilical [medbullets.com]

Laparoscopy can be used for diagnosis as well as definitive treatment of appendicitis; it may be especially helpful in women with lower abdominal pain of unclear etiology. [msdmanuals.com]

The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910. PubMed Google Scholar Browne DS. Laparoscopic-guided appendicectomy. A study of 100 consecutive cases. Aust N Z J Obstet Gynaecol 1990;30:231–233. [link.springer.com]

Epidemiology Common cause of acute abdomen Lifetime risk: 8% Peak incidence: 10–19 years of age References:[1][2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology and pathophysiology Peak incidence at 10-30yo Thought to result from obstruction of the lumen of the appendix, e.g. due to stool, lymphoid hyperplasia, vegetable matter, parasites, or neoplasm) End result is mucosal ischemia and ulceration [faculty.washington.edu]

[…] appendicitis with generalized peritonitis ICD-10: K35.3 - acute appendicitis with localized peritonitis ICD-10: K35.8 - other and unspecified acute appendicitis ICD-10: K35.80 - unspecified acute appendicitis ICD-10: K35.89 - other acute appendicitis Epidemiology [pathologyoutlines.com]

Addiss DG, Shaffer N, Fowler BS (1990)The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557. [transbiomedicine.com]

Etiology Pathophysiology Clinical features Nonspecific symptoms Progressive fever Anorexia (hamburger sign ) Nausea, vomiting, diarrhea;, and/or constipation Abdominal pain: classical presentation Initially, dull migratory periumbilical pain (due to visceral [amboss.com]

Pathophysiology • Distention of this magnitude  reflex nausea and vomiting • Capillaries and venules are occluded, but arteriolar inflow continues engorgement and vascular congestion • inflammatory process soon involves the serosa of the appendix parietal [slideshare.net]

Epidemiology and pathophysiology Peak incidence at 10-30yo Thought to result from obstruction of the lumen of the appendix, e.g. due to stool, lymphoid hyperplasia, vegetable matter, parasites, or neoplasm) End result is mucosal ischemia and ulceration [faculty.washington.edu]

[…] and young adults, most commonly occurring between early teens and 25 but may occur at any age; higher incidence in younger subjects likely related to increased lymphoid tissue More common with a low bulk Western diet, less common in Africa and Asia Pathophysiology [pathologyoutlines.com]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

To prevent conversion due to hemodynamic instability, it is mandatory to work with an ultralow intra-abdominal pressure under 8mmHg. [websurg.com]

Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention [aboutkidshealth.ca]