CHRONIC APPENDICITIS Srijana Jaisi MBBS 4th Year
Anatomy of Appendix
Blood Supply
Function • Vestigial Organ • Role in immune system: – The appendix is experimentally verified as being rich in infection-fighting lymphoid cells, suggesting that it might play a role in the immune system
Appendicitis • Inflammation of Vermiform Appendix
Types • Acute Appendicitis • Chronic Appendicitis
Chronic Appendicitis Definition • Recurrent Inflammation of Vermiform Appendix.
Causes • Partial obstruction of appendix by calculous, feces, Lymph node etc. • Inflammation and compromised blood supply to appendix
• Internal Bacterial Infection
Signs and Symptoms • • • •
Abdominal Pain Fatigue lethargy Change in bowel habit
Basic difference from Acute Appendicitis
• Mild Symptoms • Slow progression • Longer duration ( Months)
Differential Diagnosis Males • Diverticulitis • Colitis • Cystitis • Pyelonephritis • Nephrolithiasis • Inflammatory Bowel Disease • Irritable bowel Syndrome
Females • Same as in males and • Pelvic Inflammatory Disease • Chronic Ectopic Pregnancy • Endometritis • Ovarian Cyst
Diagnosis It’s very challenging
• By the time we are able to make successful diagnosis, bacteria may have slowly spread throughout the body's internal organs. Since , there is no specific symptom , chronic appendicitis can go on undetected, which in time can lead to serious complications .
Management • Conservative: – Supportive Therapy • IV Fluids
– Specific Therapy • Antibiotics ( Cefoxitin/ Ampicillin/Gentamycin/Metronidazole Because of relapsing nature a constant and long term antibiotic therapy is required.
• Surgical Management – Laparoscopic Appendectomy
• Management of Complications – Abscess Drainage – Perforation Laparotomy
Conclusion • Chronic Appendicitis is a potentially serious and diagnostically challenging condition which may have dreadful and fatal compications. • So, we have to keep in mind chronic appendicitis as a differential diagnosis whenever a patient comes to the hospital with above mentioned symptoms.
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