Essentials of Diagnosis:-


• Pain and tenderness in right iliac fossa with signs of peritoneal irritation (muscle guard and +ve Rovsing’s sign).
• Low grade fever, vomiting, constipation.
• Polymorphonuclear leucocytosis.
• Rectal tenderness is common in pelvic appendicitis;
psoas and obturator signs are positive. X-ray abdo- men shows radiopaque shadow consistent with faecolith in the appendix area.
• In infants and aged the prodromal symptoms as well as localised signs are minimum until perforation occurs.
• Tender mass in the iliac fossa with continuous fever, malaise, toxicity and marked leucocytosis indicate appendicular abscess. Pelvic abscess tends to protrude into vagina/rectum.
• Septic fever, chills, hepatomegaly and jaundice with appendicitis indicate appendicular perforation, pyelophlebitis.


Treatment:-


-Complete bed rest.
-Nothing orally.
-Laxatives and narcotics are absolutely contrain-
dicated.
-IV glucose saline.
-Nasogastric intubation with gastric lavage.
-Inj Ampicillin 500 mg 6 hourly IV, Inj Gentamycin
80 mg IM 8 hourly, Inj Metrogyl 1 g 8 hourly IV.

-Appendicectomy within 48 hrs.
Surgical


In uncomplicated cases appendicectomy is performed as soon as fluid imbalance and systemic disturbances are controlled.

Appendicular Mass

Conservative:-

• Bed rest.
• Fluid diet.
• Record temperature, pulse and size of mass.
• If mass enlarges and pyrexia continues then drain
the abscess.
• Appendicectomy after 3 months of resolution of mass.

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