← Older revision
Revision as of 02:57, 5 April 2014
(5 intermediate revisions not shown)
Line 8:
Line 8:
== Definition/Description [[Image:Appendicitis.jpg|frame|400x320px|Image of Appendicitis.]] ==
== Definition/Description [[Image:Appendicitis.jpg|frame|400x320px|Image of Appendicitis.]] ==
-
The appendix is a small finger-shaped pouch that projects out from your colon on the lower right side of your abdomen and has no known essential purpose.<ref name="Mayo Clinic">Mayo Clinic. Appendicitis. http://www.mayoclinic.org/diseases-conditions/appendicitis/basics/definition/CON-20023582. (accessed 18 Mar 2014).</ref> Appendicitis is described as the inflammation of the vermiform appendix that may result in necrosis and perforation.<ref name="Fuller">Goodman CC, Fuller K. Pathology Implications for the Physical Therapist. 3rd Edition. St. Louis, Missouri: Elsevier Saunders, 2009.</ref> Obstruction, inflammation, or infection can cause the appendix to rupture leading to peritonitis.<ref name="Goodman Synder">Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th Edition. St. Louis, Missouri: Elsevier Saunders, 2013.</ref> This condition usually requires surgery as its medical management due to the fact that acute appendicitis can often be life threatening. Thus, appendicitis is the leading cause of emergency abdominal operations.<ref name="Spirt">Spirt MJ. Complicated intra-abdominal infections: a focus on appendicitis and diverticulitis. Postgraduate Medicine. 2010;122(1):39–51.</ref> Upon
histiological
review, acute appendicitis can be divided into simple, gangrenous, or perforated categories.<ref name="Fuller" />
+
The appendix is a small finger-shaped pouch that projects out from your colon on the lower right side of your abdomen and has no known essential purpose.<ref name="Mayo Clinic">Mayo Clinic. Appendicitis. http://www.mayoclinic.org/diseases-conditions/appendicitis/basics/definition/CON-20023582. (accessed 18 Mar 2014).</ref> Appendicitis is described as the inflammation of the vermiform appendix that may result in necrosis and perforation.<ref name="Fuller">Goodman CC, Fuller K. Pathology Implications for the Physical Therapist. 3rd Edition. St. Louis, Missouri: Elsevier Saunders, 2009.</ref> Obstruction, inflammation, or infection can cause the appendix to rupture leading to peritonitis.<ref name="Goodman Synder">Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th Edition. St. Louis, Missouri: Elsevier Saunders, 2013.</ref> This condition usually requires surgery as its medical management due to the fact that acute appendicitis can often be life threatening. Thus, appendicitis is the leading cause of emergency abdominal operations.<ref name="Spirt">Spirt MJ. Complicated intra-abdominal infections: a focus on appendicitis and diverticulitis. Postgraduate Medicine. 2010;122(1):39–51.</ref> Upon
histological
review, acute appendicitis can be divided into simple, gangrenous, or perforated categories.<ref name="Fuller" />
== Prevalence/Incidence ==
== Prevalence/Incidence ==
-
The lifetime risk of appendicitis in the
Unitied
States is 9% for males and 7% for females. It is most commonly diagnosed in adolescents and younger adults. Overall incidence of this condition is declining for reasons not well known. It is suggested that increased dietary fiber intake and improved hygiene could be contributing factors to the decrease in appendicitis cases. <br>
+
The lifetime risk of appendicitis in the
United
States is 9% for males and 7% for females. It is most commonly diagnosed in adolescents and younger adults. Overall incidence of this condition is declining for reasons not well known. It is suggested that increased dietary fiber intake and improved hygiene could be contributing factors to the decrease in appendicitis cases. <br>
== <ref name="Fuller" /> ==
== <ref name="Fuller" /> ==
Line 57:
Line 57:
== Diagnostic Tests/Lab Tests/Lab Values ==
== Diagnostic Tests/Lab Tests/Lab Values ==
-
Diagnostic testing is often indicated for individuals suspected of having appendicitis. Medical imaging such as CT scans, sonograms, or abdominal X-rays are used to help confirm possible appendicitis. Additional laboratory tests
utilzed
are urine analyses, to make sure that a urinary tract infection or a kidney stone isn't causing the pain, or complete blood counts. Patients who present with typical appendicitis will have an elevated WBC count > 20,000 mm<sup>3</sup>. Physicians will also perform a histological examination of the resected appendix for further confirmation of the condition. Iliopsoas and obturator muscle tests are administered to rule out potential
abcesses
or insults to muscle integrity.
+
Diagnostic testing is often indicated for individuals suspected of having appendicitis. Medical imaging such as CT scans, sonograms, or abdominal X-rays are used to help confirm possible appendicitis. Additional laboratory tests
utilized
are urine analyses, to make sure that a urinary tract infection or a kidney stone isn't causing the pain, or complete blood counts. Patients who present with typical appendicitis will have an elevated WBC count > 20,000 mm<sup>3</sup>. Physicians will also perform a histological examination of the resected appendix for further confirmation of the condition. Iliopsoas and obturator muscle tests are administered to rule out potential
abscesses
or insults to muscle integrity.
== <ref name="Fuller" /> ==
== <ref name="Fuller" /> ==
Line 91:
Line 91:
If the appendix has ruptured and infection has spread beyond the appendix or if an abscess is present, immediate surgery through laparotomy may be required to clean the abdominal cavity and remove the appendix. If the infection is not treated peritonitis can develop. If the infection spreads to the blood sepsis can develop.<ref name="NDDIC II" /> <br>One or two days is usually spent in the hospital after an appendectomy.<sup>[[Image:Open Appendectomy.jpg|thumb|312x422px|Open Appendectomy removes the appendix through a single incision. Image From: http://www.zadehsurgical.com/general-surgery-services-encino/appendicitis/]]</sup><ref name="Mayo Clinic" />
If the appendix has ruptured and infection has spread beyond the appendix or if an abscess is present, immediate surgery through laparotomy may be required to clean the abdominal cavity and remove the appendix. If the infection is not treated peritonitis can develop. If the infection spreads to the blood sepsis can develop.<ref name="NDDIC II" /> <br>One or two days is usually spent in the hospital after an appendectomy.<sup>[[Image:Open Appendectomy.jpg|thumb|312x422px|Open Appendectomy removes the appendix through a single incision. Image From: http://www.zadehsurgical.com/general-surgery-services-encino/appendicitis/]]</sup><ref name="Mayo Clinic" />
-
<br>Currently, research on antibiotic therapy alone has increased in popularity across the world. In 1997, 1 million hospitalizations for acute appendicitis were reported and roughly three billion dollars was spent on patient care.<ref name="Wilms">Wilms IMHA, de Hoog DENIM, de Visser DC, Janzing HMJ. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Reviews 2011;11:1-34.(accessed 17 March 2014).</ref> A recent systematic review published in 2011 compared the effects of antibiotic treatment to appendectomies on success rate and overall complications experienced after treatment. Researchers found that 73.4% of those treated with antibiotic therapy (415/901) were free of abdominal pain, fever, inflammatory markers within two weeks and were without major complications and
recurrance
within one year. On the other hand, 97.4% of those who had an appendectomy (486/901) had similar outcomes. It was noted that patients who had surgery had a shorter duration of hospital stay. Due to the fact that the 5 RCTs analyzed in this review were low to moderate quality, the authors could not make direct conclusions about the effectiveness of antibiotic therapy over traditional surgery. <ref name="Wilms" /><br>
+
<br>Currently, research on antibiotic therapy alone has increased in popularity across the world. In 1997, 1 million hospitalizations for acute appendicitis were reported and roughly three billion dollars was spent on patient care.<ref name="Wilms">Wilms IMHA, de Hoog DENIM, de Visser DC, Janzing HMJ. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Reviews 2011;11:1-34.(accessed 17 March 2014).</ref> A recent systematic review published in 2011 compared the effects of antibiotic treatment to appendectomies on success rate and overall complications experienced after treatment. Researchers found that 73.4% of those treated with antibiotic therapy (415/901) were free of abdominal pain, fever, inflammatory markers within two weeks and were without major complications and
recurrence
within one year. On the other hand, 97.4% of those who had an appendectomy (486/901) had similar outcomes. It was noted that patients who had surgery had a shorter duration of hospital stay. Due to the fact that the 5 RCTs analyzed in this review were low to moderate quality, the authors could not make direct conclusions about the effectiveness of antibiotic therapy over traditional surgery. <ref name="Wilms" /><br>
-
<br>Another systematic review published in 2011 also found similar inconclusive results regarding the efficacy of antibiotic therapy on acute appendicitis. In this study, 489/741 patients underwent antibiotic therapy. Although the number of individuals who developed complications were significantly higher in the surgery group, the percentage of experiencing acute appendicitis within the first year follow up and immediate 48 hour surgery
varried
from 10.5 to 36.8% and 5 to 47.5%, respectively.<ref name="Ansaloni">Ansaloni L, et al. Surgery versus conservatice antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized control trials. Digestive Surgery 2011;28:210-21.(accessed 17 March 2014).</ref>
+
<br>Another systematic review published in 2011 also found similar inconclusive results regarding the efficacy of antibiotic therapy on acute appendicitis. In this study, 489/741 patients underwent antibiotic therapy. Although the number of individuals who developed complications were significantly higher in the surgery group, the percentage of experiencing acute appendicitis within the first year follow up and immediate 48 hour surgery
varied
from 10.5 to 36.8% and 5 to 47.5%, respectively.<ref name="Ansaloni">Ansaloni L, et al. Surgery versus conservatice antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized control trials. Digestive Surgery 2011;28:210-21.(accessed 17 March 2014).</ref>
== Physical Therapy Management (current best evidence) ==
== Physical Therapy Management (current best evidence) ==
-
Currently there is no research available on physical therapy
managment
of appendicitis. This condition is
viseral
in nature and is managed most effectively by surgical procedures. Physical therapists have an important role in recognizing signs and symptoms of this disease so patients can seek medical attention in a timely manner. It is imperative that physical therapists take detailed subjective histories and conduct abdominal screenings accurately so appropriate referrals can be made.
+
Currently there is no research available on physical therapy
management
of appendicitis. This condition is
visceral
in nature and is managed most effectively by surgical procedures. Physical therapists have an important role in recognizing signs and symptoms of this disease so patients can seek medical attention in a timely manner. It is imperative that physical therapists take detailed subjective histories and conduct abdominal screenings accurately so appropriate referrals can be made.
Physical therapist may see patients post appendectomy. Therapist should be aware of the incision site between the anterior superior iliac spine and umbilicus. Patient education would include avoiding strenuous activity, supporting the abdomen when coughing, and breathing exercises.
Physical therapist may see patients post appendectomy. Therapist should be aware of the incision site between the anterior superior iliac spine and umbilicus. Patient education would include avoiding strenuous activity, supporting the abdomen when coughing, and breathing exercises.
Line 103:
Line 103:
== Alternative/Holistic Management (current best evidence) ==
== Alternative/Holistic Management (current best evidence) ==
-
Due to the high success rate of surgical management for acute appendicitis, there is limited evidence on alternative or holistic
managment
. A recent case study by Gershfeld, Sultana, and Goldhamer in 2011 reported positive outcomes for a patient with subacute appendicitis. In this study a 46 year old man was medically supervised on a water only fasting program for seven days. The patient then followed a strict low sodium and low fat diet after he was reintroduced to foods. He was further advised to continue the diet after leaving the medical facility. The participant reported
decreaed
right lower quadrant pain at three months, one year, and two year follow ups. The exact mechanism for how the fasting regime worked are not well understood. Fasting protocols have reported some success in inflammatory conditions like SLE, RA, and IBS. <ref name="Gershfeld">Gersheld N, Sultana P, Goldhamer A. A case of nonpharmacologic conservative management of suspected uncomplicated subacute appendicitis in an adult male. Journal of Complementary Medicine 2011;17(3):275-77.http://www.ncbi.nlm.nih.gov/pubmed/?term=a+case+of+nonpharmacological+conservative+management+fo+suspected+uncomplicated+subacute+appendicitis+in+an+adult+male. (accessed 18 March 2014).</ref><br>
+
Due to the high success rate of surgical management for acute appendicitis, there is limited evidence on alternative or holistic
management
. A recent case study by Gershfeld, Sultana, and Goldhamer in 2011 reported positive outcomes for a patient with subacute appendicitis. In this study a 46 year old man was medically supervised on a water only fasting program for seven days. The patient then followed a strict low sodium and low fat diet after he was reintroduced to foods. He was further advised to continue the diet after leaving the medical facility. The participant reported
decreased
right lower quadrant pain at three months, one year, and two year follow ups. The exact mechanism for how the fasting regime worked are not well understood. Fasting protocols have reported some success in inflammatory conditions like SLE, RA, and IBS. <ref name="Gershfeld">Gersheld N, Sultana P, Goldhamer A. A case of nonpharmacologic conservative management of suspected uncomplicated subacute appendicitis in an adult male. Journal of Complementary Medicine 2011;17(3):275-77.http://www.ncbi.nlm.nih.gov/pubmed/?term=a+case+of+nonpharmacological+conservative+management+fo+suspected+uncomplicated+subacute+appendicitis+in+an+adult+male. (accessed 18 March 2014).</ref><br>
== Differential Diagnosis ==
== Differential Diagnosis ==