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Appendicitis: Vomiting
built 614 days ago
If a diagnosis of appendicitis is confirmed, surgery to remove the inflamed appendix is the recommended course of treatment. Because of the danger that the appendix may rupture, surgery is usually done soon after the diagnosis is made.
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It is important that persons with symptoms of appendicitis not take laxatives or enemas to relieve constipation, as these medications and procedures can cause the appendix to burst. In addition, persons should ... avoid taking pain medication, as this can mask other symptoms the physician needs to be aware of.
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Clinical scoring systems are attractive because of their simplicity; ... none has been shown prospectively to improve on the physician's judgment in the subset of patients evaluated in the ED for abdominal pain suggestive of appendicitis. The MANTRELS score, in fact, was based on a population of patients hospitalized for suspected appendicitis, which differs markedly from the population seen in the ED.
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The classical physical finding in appendicitis is diffuse pain in the umbilical region which can become localised at McBurney's point if the inflammed appendix comes into contact with the parietal peritoneum. This point is located on the right-hand side one-third of the distance between the anterior superior iliac spine and the navel, or approximately one hand's width.
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There is a slightly higher rate of appendicitis in the second trimester than in the first and third trimesters or postpartum [5]. An infected appendix appears to be more likely to rupture during pregnancy, especially in the third trimester, possibly because of delay in diagnosis and intervention [7,8].
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The high rate of complicated appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is primarily the direct result of patient delay in seeking medical attention and not the result of diagnostic dilemma or surgical delay. Public education, specifically targeting those groups at risk, may provide a substantial and significant solution to the complicated appendix.
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