Apendicitis aguda
Summary
Definition
La apendicitis aguda es una inflamación aguda del apéndice vermiforme, muy probablemente debida a la obstrucción del lumen del apéndice (mediante fecalito, heces normales, agentes infecciosos o hiperplasia linfoide).[1][2][Figure caption and citation for the preceding image starts]: Apendicitis aguda: muestra intraoperatoriaNasim Ahmed, MBBS, FACS; usado con autorización [Citation ends].
History and exam
Key diagnostic factors
- dolor abdominal
- anorexia
- náuseas y vómitos
- sensibilidad a la palpación en el cuadrante inferior derecho
- Puntuación de riesgo "alta" o "intermedia"
- abdomen tenso y rígido
- hipotensión y taquicardia
- masa palpable
Other diagnostic factors
- edad de presentación
- pirexia de bajo grado
- cara sonrojada y hedor
- reducción de los ruidos intestinales
- taquicardia
- deposición diarreica
- estreñimiento
- cadera derecha flexionada (signo del psoas)
Risk factors
- mejor higiene personal
- tabaquismo
Diagnostic tests
1st tests to order
- hemograma completo (HC)
- proteína C-reactiva
- ultrasonido de abdomen
- TC abdominal con contraste
Tests to consider
- análisis de orina
- prueba de embarazo
- agrupe y guarde
- resonancia magnética (IRM) abdominal
Emerging tests
- ratio de neutrófilos a linfocitos
- sodio sérico
- pentraxina-3
- amiloide A sérico
- índices plaquetarios
Treatment algorithm
Apendicitis sin complicaciones: adultos
apendicitis sin complicaciones: niños
apendicitis complicada: adultos
apendicitis complicada: niños
Contributors
Expert advisers
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Biography
JA is Clinical Lead for General Surgery, Getting It Right First Time.
Disclosures
JA is trustee and council member of the Royal College of Surgeons of England.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:
Dileep N. Lobo, MS, DM, FRCS, FACS
Professor of Gastrointestinal Surgery
National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit
Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre
Nottingham
UK
DNL declares that he has no competing interests. DNL is an author of an article cited in the topic.
Peer reviewers
Sarah Richards
General Surgeon
Royal United Hospitals
Bath NHS Foundation Trust
UK
Biography
SR is a specialty advisor in emergency general surgery to the Royal College of Surgeons and an honorary senior clinical lecturer and examiner for the University of Bristol medical school.
Disclosures
SR declares that she has no competing interests.
Kokila Lakhoo, PhD, FRCS, FCS (Paediatrics) MRCPCH, MBCHB
Consultant Paediatric Surgeon
Children’s Hospital in Oxford and the University of Oxford
UK
Declarações
KL declares that she has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.Texto completo Resumo
Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis: EAES consensus development conference 2015. Surg Endosc. 2016 Nov;30(11):4668-90.Texto completo Resumo
Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Adenitis mesentérica aguda
- Gastroenteritis viral
- Diverticulitis de Meckel
Mais Diagnósticos diferenciaisDiretrizes
- Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
- Commissioning guide: emergency general surgery (acute abdominal pain)
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