Acute appendicitis is a surgical emergency most frequently caused by an obstruction of the communication between Ilion and appendix. It causes an inflammation of the mucous layer because of the colonization with intestinal bacterial flora. In case of appendix perforation, fecal matter and infected intestinal bodies pierce into the peritoneum and cause acute septic peritonitis. Depending on the infected area, the peritonitis can be local or general; around the inflamed appendix an abscess can appear.

About 10% of the population is expected to develop appendicitis in the near future but the incidence is decreasing. Appendicitis is commonly resolved by appendicectomy, the removal of the appendix. The occurrence of normal appendix removal is 10-20% of the suspected cases.

The inflammation of the appendix usually occurs in men but the chance of removing a healthy appendix is higher in young women. The trickiest situations of appendicitis are seen in children and old people who don't always develop the classical symptoms; this is the major reason for wrong and false diagnosis of appendicitis.

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The pain usually appears around the navel or in the epigastria and moves down and right in the right ileal fossa after several hours, when the inflammation process involves the peritoneum. Pains get worse as hours pass, they can awake or keep awaken a patient. The pain tends to get worse while moving or coughing and the person tries to stay still and in an antalgic position to calm the aches.

Next appearing symptoms are nausea, vomiting and sometimes anorexia. Most common is constipation because the inflammation process tends to slow down the intestinal transit. Diarrhea can also occur, mostly without fever when the appendix is localized after the Ilion, in an abnormal position.

Pulse and temperature are normal in the debut period but can increase as the peritoneum is caught or an infection develops.

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In the right ileal fossa a sensation of tenderness and discomfort can persist. Pain can be worsen by touching the area, and the inflammation of the peritoneum can be also checked by touch methods.

In spite of the suggestive symptoms, a retro-cecal or in the pelvis situated appendix can be missed or misinterpreted. Such cases of appendicitis can only be diagnosed by rectal touché.

Objective clinical tests to prove the inflammation of the appendix are:

1.The Psoas test- from the right side of the patient extend the hip and perform the abduction of the thigh.

2. The obturatory-muscle test- flexing the right thigh and rotating the hip to the interior.

3. The Rovsink test to cause pain in the right ileal fossa while pressing the left ileal fossa.

4. The rebound- pain after releasing the pressure exercised in the right ileal fossa, means the peritoneum is interested.

After the appendix perforation patients may feel less pain, but the rising pulse and other developing symptoms appear showing the peritonitis.

Atypical symptoms for appendicitis are watery diarrhea and vomiting, anorexia and diffuse abdominal pain, shock and confusion in older persons. Pregnant women usually feel the pains higher in the abdomen.



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