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Thursday, 5 December 2013

Appendicitis:The Causes and risk factors

Appendicitis is defined as a condition of inflammation of Appendix. It is classified as an emergency, in many required the removal of the appendix. If burst, or perforate, spilling infectious materials into the abdominal cavity can be life threatening.
II. Causes and risk factors
A. Causes
The cause of appendicitis is the result of blockage by stool, a foreign body, or cancer of that can lead to infection.
1, Bacterial, viral and parasitic infiection
According to the study by the, the pathologic spectrum of the inflamed appendix encompasses a wide range of infectious entities, some with specific histologic findings, and others with nonspecific findings that may require an extensive diagnostic evaluation. The appendix is exclusively involved in some of these disorders, and in others may be involved through extension from other areas of the gastrointestinal tract(4). Other sin the study to investigate the role of parasitic infestation in the etiology of acute pediatric appendicitis, indicated that parasites were present in 5.5% (88 patients), and of those 88 parasitic infestations, 45 (51.1%) were Enterobaisis, 8 (9.1%) were Schistosomiasis, 23 (26.1%) were Ascariasis, 7 (8%) Trichuriasis, and 5 (5.7%) were Teania Saginata. The percentage of patients with suppurative, gangrenous or perforated appendicitis was similar in both groups with no statistical significance, irrespective of the presence or absence of parasitic infestation(5).
2. Foreign objects
Appendicitis and its complications remain a common problem affecting patients of all age groups. Appendicitis due to foreign bodies is rare and carries an estimated frequency of 0.0005%. But Aaccording to the Department of Surgery, Heilig Hart Tienen, ther is case of a 44-year-old man with appendicitis induced by an appendicolith containing eight steel shotgun pellets. The man was a recreational hunter and for the past 20 years he consumed wild game on a regular basis(6).
B. Risk factors
1. Age 10 × 103/mm
In the study to evaluate the impact of timing of appendectomy and other potential risk factors on progression of acute appendicitis, by searching the relevant databases of a tertiary medical center identified 1,604 patients with verified acute appendicitis who underwent appendectomy in 2004-2007with demographic and clinical data and time from symptom onset to emergency room admission (“patient interval”) and from emergency room admission to surgery (“hospital interval”) and their combination were analyzed by pathological grade, indicated that on multivariate analyses, independent risk factors for appendiceal perforation were age 50 years (OR = 2.84, 95 % CI 1.82-4.45) (relative to 20-50 years), white cell count >10 × 103/mm(3) (OR = 4.45, 95 % CI 2.05-9.67), body temperature >37.8 °C (OR = 2.23, 95 % CI 1.45-3.41), hospital interval >24 h (OR = 2.84, 95 % CI 1.49-5.4), patient interval >48 h (OR = 3.84, 95 % CI 2.35-6.29), and combined interval >48 h (OR = 4.29, 95 % CI 2.2-8.36)(7).
2. Gender different, among young
According to study appendicitis is common among young, healthy populations; appendectomy is one of the most common surgical procedures performed in the United States. Among active and reserve component members, there were 31,610 cases of appendicitis and 30,183 appendectomies during 2002 to 2011. The overall incidence rate of appendicitis in the active component was 18.4 per 10,000 person-years (p-yrs). Active component males reported greater rates of perforated appendicitis (2.6 per 10,000 p-yrs). Active component females had higher rates of incidental appendectomies (2.6 per 10,000 p-yrs)(8).
3. Race, increased over time and is higher in the summer months
Appendicitis is most common in whites and Hispanics and less common in African Americans and Asians and incidence has increased over time and is higher in the summer months, according to the study by the University of California San Diego(9).
4. Prior antibiotic administration
Prior treatment with antibiotics was an independent risk factor for therapeutic delay in pediatric AA, according to the study by the National Center for Child Health and Development, Tokyo(10).
5. Decreased bowel sounds; rebound tenderness; and presence of psoas, obturator, or Rovsing’s signs
Factors associated with an increased likelihood of appendicitis included decreased bowel sounds; rebound tenderness; and presence of psoas, obturator, or Rovsing’s signs(11).
6. In patients with end-stage renal disease
The independent risk factors were atrial fibrillation (hazard ratio [HR], 2.08), severe liver disease (HR, 1.74), diabetes mellitus (HR, 1.58), and hemodialysis (HR, 1.74), according to the study by the Taipei Medical University(12).
7. Severity of inflammation
CRP concentration may be a potent objective predictor of pathological severity in appendicitis. Combination with the other diagnostic modalities may improve the diagnostic accuracy in predicting the severity of appendicitis(13).
8. Other risk factors
The principal factors contributing to perforation of appendix are: age of children, delays of surgical intervention, family anamnesis, social group and late recognition of symptoms of appendicitis(14).
9. Appendicolith
Presence of an appendicolith was associated with a 72% rate of recurrent appendicitis compared with a recurrence rate of 26% in those with no appendicolith (chi2 test, P < .004)(15).
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Sources
(5) http://www.ncbi.nlm.nih.gov/pubmed/23599875
(6) http://www.ncbi.nlm.nih.gov/pubmed/23397832
(7) http://www.ncbi.nlm.nih.gov/pubmed/23374326
(8) http://www.ncbi.nlm.nih.gov/pubmed/23311330
(9) http://www.ncbi.nlm.nih.gov/pubmed/22948195
(10) http://www.ncbi.nlm.nih.gov/pubmed/22858754
(11) http://www.ncbi.nlm.nih.gov/pubmed/22849662
(12) http://www.ncbi.nlm.nih.gov/pubmed/22777056
(13) http://www.ncbi.nlm.nih.gov/pubmed/22234068
(14) http://www.ncbi.nlm.nih.gov/pubmed/10965688
(15) http://www.ncbi.nlm.nih.gov/pubmed/16226993