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Appendicitis (also called epityphlitis〔(MerriamWebster definition )〕) is inflammation of the appendix. Appendicitis commonly presents with right iliac fossa abdominal pain, nausea, vomiting, and decreased appetite. However, one third to a half of persons do not have these typical signs and symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.〔 Appendicitis is caused by a blockage of the hollow portion of the appendix, most commonly by a calcified "stone" made of feces. However, inflamed lymphoid tissue from a viral infection, parasites, gallstone or tumors may also cause the blockage. This blockage leads to increased pressures within the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation.〔 The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death. If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to severe abdominal pain and increased complications.〔〔Barrett ML, Hines AL, Andrews RM. Trends in Rates of Perforated Appendix, 2001–2010. HCUP Statistical Brief #159. Agency for Healthcare Research and Quality, Rockville, MD. July 2013. ()〕 The diagnosis of appendicitis is largely based on the person's signs and symptoms.〔 In cases where the diagnosis cannot be made based on the person's history and physical exam, close observation, radiographic imaging and laboratory tests can often be helpful. The two most common imaging tests used are ultrasound and computed tomography (CT scan).〔 CT scan has been shown to be more accurate than ultrasound in detecting acute appendicitis. However, ultrasound may be preferred as the first imaging test in children and pregnant women because of the risks associated with radiation exposure from CT scans.〔 The standard treatment for acute appendicitis is surgical removal of the appendix.〔〔 This may be done by an open incision in the abdomen (laparotomy) or through a few smaller incisions with the help of cameras (laparoscopy). Surgery decreases the risk of side effects or death associated with rupture of the appendix. Antibiotics may be equally effective in certain cases of non-ruptured appendicitis. It is one of the most common and significant causes of severe abdominal pain that comes on quickly worldwide. In 2013 it resulted in 72,000 deaths globally. In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery.〔 Each year in the United States, more than 300,000 persons with appendicitis have their appendix surgically removed. Reginald Fitz is credited with being the first person to describe the condition in a paper published in 1886. ==Signs and symptoms== Initially, abdominal pain, nausea, vomiting, and last fever have been described and have been considered as the classic presentation of acute appendicitis. Since the innervation of the appendix enters the spinal cord at the same level as the umbilicus (belly button), the abdominal pain becomes so intense and unbearable. As the appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. This leads to the localization of the pain to the right lower quadrant. This classic migration of pain may not be seen in children under three years. This pain can be elicited through various signs and can be severe. Signs include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation). Also, there is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). If the appendix is retrocecal (localized behind the cecum), even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix). This is because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point). 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Appendicitis」の詳細全文を読む スポンサード リンク
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