Resumo
Definição
A apendicite aguda é uma inflamação aguda do apêndice vermiforme, muito provavelmente decorrente de obstrução do lúmen do apêndice (por fecálito, fezes normais, agentes infecciosos ou hiperplasia linfoide).[1][2][Figure caption and citation for the preceding image starts]: Apendicite aguda - espécime intraoperatórioNasim Ahmed, MBBS, FACS; usado com permissão [Citation ends].
História e exame físico
Principais fatores diagnósticos
- dor abdominal
- anorexia
- náuseas e vômitos
- sensibilidade no quadrante inferior direito
- Pontuação de risco “alta” ou “intermediária
- abdome tenso e rígido
- hipotensão e taquicardia
- massa palpável
Outros fatores diagnósticos
- idade de ocorrência
- pirexia de baixo grau
- rosto corado e halitose
- ruídos hidroaéreos reduzidos
- taquicardia
- evacuação diarreica
- constipação
- quadril direito flexionado (sinal de psoas)
Fatores de risco
- melhor higiene pessoal
- fumar
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Hemograma completo
- proteína C-reativa
- ultrassonografia abdominal
- tomografia computadorizada abdominal com contraste
Investigações a serem consideradas
- urinálise
- teste de gravidez
- tipagem e reserva de sangue
- ressonância nuclear magnética (RNM) abdominal
Novos exames
- proporção neutrófilos/linfócitos
- sódio sérico
- pentraxina-3
- amiloide A sérica
- índices plaquetários
Algoritmo de tratamento
apendicite não complicada: adultos
apendicite não complicada: crianças
apendicite complicada: adultos
apendicite complicada: crianças
Colaboradores
Consultores especialistas
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
Disclosures
KL declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Adenite mesentérica aguda
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- Diverticulite de Meckel
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- 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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