Apendisit ɓuuɓɗo, Apendisit ruppitiiɗo, e Peritonitis Banngeeji boɗeeji¶

Appendisit ɓuuɓɗo ko ñawu nguu ɓuri heewde e winndere ndee kala, ngu waɗata ko nde ɓuuɓri nder reedu (lumen) appendix vermiforme, ɓuuɓri gonndi e koppi, jokkondirndi e fuɗɗoode ɓalndu mawndu (cecum) e nder reedu les ñaamo harkeol ofstone, wonti (fecalith), ɓuuɓri limfoyid caggal nde mboros oo heɓi ɗum, aawdi walla ɓuuɓri jananndi, walla ɓuuɓri. So tawii ko ɓuuɓri nanngaandi e bakteriiji guurɗi keewɗi ina ɓuuɓna appendix udditirɗo oo no pneu ɓuuɓɗo nii, ina ɓuuɓna ƴiiƴam ɗam e nder ɓalndu nduu haa ƴiiƴam ɗam wayla gangrene e ɓuuɓde (appendix perforated walla ruptured of), ina ɓuuɓna listerile across de miliyoŋaaji ɓuuɓri reedu (peritonitis bakteriiji kuuɓtodinɗo e... sepsis).

Kuule maa ko yaawi so tawii ko apendisit ɓuuɓɗo walla peritonitis tuumaama ko anndude eggugol nafoore gonnde e nder reedu-to-somatik (nafoore ɓuuɓnde e saraaji reedu nde waylotoo caggal waktuuji 4 haa 12 e nder nafoore tiiɗnde, ɓuuɓnde e nder toɓɓere lesre ñaamo to McBfour Lull"** (ɗo nafoore ɓuuɓnde ina ustoo ɗoon e ɗoon fotde waktuuji 1 haa 3 e sahaa nde apendiis oo feeñata, ko adii nde peritonitis yaajɗo oo naatata), haɗde no feewi kala ko ñaametee, ndiyam, laxatives, enemas, e pads nguleeki, ndarnee ñawɗo oo e dow jam e dow ɓalewol mum en e pillowla mum en wall, e yuɓɓinde yah-ngartaa departemaa emergency ko yaawi ngam ƴeewndaade seppooji.

Waɗde ɗum jooni¶

1. Yiylo ballal ko yaawi to suudu safrirdu (walla noddude ambulance so tawii peritonitis walla maale sokla ina ngoodi): Yah to suudu safrirdu ɓurndu ɓadaade ɗoon e ɗoon so tawii neɗɗo ina wondi e ñawu reedu ngu eggude walla jooɗaade e reedu les ñaamo, **hurts sharply waling, go, or cough ina wondi e waasde ñaamde (anorexie), ɓuuɓri, ɓuuɓri, walla ɓuuɓri lowre. Noddu limoore emergency nokkuure maa (911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 to Dental Orop, 999 to leydi Angalteer, 000 to Ostarali) walla ƴeewto regginorde amen e... limooje caɗtuɗe ɗoon e ɗoon so reedu nduu ina nanndi e no alluwal nii, ina tiiɗi, neɗɗo oo ina jogii ɓuuɓri toowndi ko ina tolnoo e 38,5 degere Celsius (101,3 degere Fahrenheit) e ɓuuɓri, walla ɓe nana ɓuuɓri, ɓuuɓri, e ɓuuɓri.
2. Hokkude hay huunde e hunuko (NPO: alaa ko ñaametee, alaa ko ndiyam, alaa ko ñamlata): Woppu ñaamde e yarde fof ɗoon e ɗoon. Appendix ɓuuɓɗo ina ɗaɓɓi laparoskopi walla appendix udditirɗo e nder anestesi kuuɓtodinɗo, tawa kadi jogaade nguura walla ndiyam e nder reedu ina ɓeyda baasal pneumonie aspiration letale so anestesi waɗaama.
3. Hoto meeɗ rokkude laxatives, softeende ƴiiƴam, walla enema ngam tuumeede apendisit: Hay so neɗɗo oo ina wondi e ɓuuɓri walla ina wondi e "yiɗde ɓuuɓde gaas walla ƴiiƴam mo yaltataa" (tenesmus ummoraade e appendix pelvic irritant le rectum), **woto meeɗ rokkude enema laxative walla Udditde ɓuuɓri ɓalndu tiiɗndi (peristalsis) e dow apendiis ɓuuɓɗo, gangrenous ina ɓuuɓna ɓanndu nduu, ina addana ɓalndu nduu ɓuuɓde ɗoon e ɗoon e peritonitis fecal.
4. Woto meeɗ waɗde paddorde nguleeki walla ɓuuɓri ndiyam ngulɗam e reedu : Waɗde nguleeki e apendiis ɓuuɓɗo ina yaaji e ƴiiƴam nokku oo, ina yaawi ɓeydaade bakteriiji e mooftude ɓuuɓri e nder lumen ɓuuɓɗo, ina yaawi kadi ɓuuɓde gangrene.
5. Fofto haa jooni e nder mbaydi ɓuuɓndi koppi: Waɗde neɗɗo oo ina lelna haa jooni e dow koyngal mum (walla seeɗa e bannge ñaamo mum) tawa piilngal gootal walla ɗiɗi ina fawii e les koppi mum ɓuuɓɗi e ŋoral mum. Beɗɗude koppi e koppi ina ɓuuɓna ɓalndu psoas e ɓalndu ɓalndu yeesooru, ina itta ɓuuɓri mekanik mettundi e ɓalndu ɓuuɓndu nduu.
6. Woto fooɗtu e ɓuuɓri ɓuuɓndi waktuuji 1 haa 3 ("The Treacherous Lull of Perforation"): So tawii neɗɗo mo ɓuuɓnaaki e ɓuuɓri les reedu ñaamo fotde waktuuji 18 haa 36, ɗoon e ɗoon ina ɓuuɓtoo e ɓuuɓri, ina wiya tan "The sharpd we not galle*. So appendix gangrenous ɓuuɓɗo yanii, ɓuuɓol nder reedu ina ustoo haa wona waktuuji 1 haa 3 hade mum ɓuuɓde e bakteriiji ɓuuɓde peritonitis kuuɓtodinɗo baawɗo warde e nder reedu nduu fof.

flowchart TD
    Start["Dull Mid-Abdominal / Button Naafigaagal + Ɓooygol ñaamde, Ɓooygol, walla Ɓooygol Lowre Yahde e Les Reedu Ñaamo"] --> CheckPeritonitis{"1. Ƴeewto Banngeeji Boɗeeji ngam Rupture / Peritonitis : Reedu tiiɗndu nanndundu e alluwal, Naafigaagal e kala ɓuuɓri/Kosam, Feere mawnde (>38.5 C), walla Shock ?"}
    CheckPeritonitis -->|Yes| CallEMS["Noddu sarwisaaji toppitiiɗi ko fayti e cellal (911 / 112 / 999) Ɗoon e ɗoon : Tuumaaɗo Appendix perforé e Peritonitis"]
    CheckPeritonitis -->|No / Localized RLQ Pain| UrgentED["Jaɓɓungal ɗoon e ɗoon to Departemaa Emergency Hospitaal (Wonaa Clinique Ambulatoire)"]
    CallEMS --> CheckLull{"2. Mbele Naafigaagal mawngal ina majja ɗoon e ɗoon (‘Pop’), tawi noon ɓuuɓri ɓernde ina heddii e yaawre (>100 bpm) ?"}
    UrgentED --> CheckLull
    CheckLull -->|Yes| LullAlert["Anndu ‘The Perforation Lull’: Yah ɗoon e ɗoon to Departemaa Emergency Hay so tawii ko ballal wakkati"]
    CheckLull -->|No| Position["3. Joɗɗinde Supine e Pillows Les Koppi Bent ngam ɓuuɓnude Wall reedu e Psoas Muscle"]
    LullAlert --> Position
    Position --> Prohibitions["4. Alaa ko woni e hunuko (Alaa ko ñaametee walla ko ndiyam), alaa ko Laxatives/Enemas, alaa ko woni e ɓuuɓri, alaa ko woni e AINE"]

Ko waɗi nafoore apendisit ina diwa : Naafigaagal periumbilical visceral e nafoore toɓɓere McBurney somatik¶

Ko ɓuri laaɓtude e ko seerndi apendisit ɓuuɓɗo e ɓuuɓri reedu ko migration chronologique de douleur, tawa ina tawee e 50 haa 60 e nder teemedere e ñawɓe ɓooyɓe (e ko ɗum faamninaa e wiring nerve embryonal e nder ɓalndu neɗɗo) :

Ko waɗi 40 e nder teemedere ñawɓe apendisit ƁURI ƁURDE ƁURDE e nokku McBurney : nokkuuji anatomiiji cuuɗiiɗi¶

So tawii daande appendix ina jokkondiri e cecum e nder reedu les ñaamo, tip free appendix ina yahra, ina waawi hollitde banngeeji keewɗi ceertuɗi no juuɗe waktu nii. E fawaade e ɗo tip ɓuuɓɗo oo jooɗii, maale ñawɗo oo ina mbaawi nanndude e ɓuuɓri ɓaleeri, ɓuuɓri ƴiiƴam, walla ɓuuɓri reedu :

1. Appendix retrocecal (Tippol ngol ina tuugii caggal ƴiiƴam cecum, 60% e yimɓe, ina heewi ko retroperitoneal):
2. Sabu appendix ɓuuɓɗo oo ina reeni caggal cecum keewɗo henndu, tee memotaako peritoneum wall reedu yeeso, toɓɓude e yeeso reedu to nokku McBurney ina waawi saabaade ɓurtugol ɓuuɓngol haawningol walla luggiɗngol, tee ɓuuɓri ina waawi waasde mettude no feewi.
3. E nder ɗuum, apendiis oo ina fawii e dow ɓuuɓri iliopsoas ñaamo e ureter ñaamo, ina addana nafoore luggiɗnde e bannge ñaamo walla les ɓalndu, nafoore so ina fooɗta walla ina yaajina ɓalndu ñaamo caggal (Positive Psoas Sign / limping on the pied right), e trisco blood e nder ɓalndu ƴeewndo ngo moƴƴaani a kaaƴe ƴiiƴam walla ɓuuɓri ƴiiƴam.
4. Appendix pelvis (Tip gonɗo les dow ŋoral pelvis e nder pelvis goonga, 30% e yimɓe):
5. Reedu yeeso ina nanndi e softugol timmungol e ɓuuɓri seeɗa to nokku McBurney.
6. Sabu tip ɓuuɓɗo oo ina fawii e ɓuuɓri ƴiiƴam e wall anterior rectum, ina ɓuuɓna terɗe ɗiɗi ɗee kala :
   • Ɓuuɓri ɓuuɓri: Ina addana ɓuuɓri ɓuuɓndi, keewndi (disuria e ɓuuɓri ɓuuɓri) nanndundi no feewi e ɓuuɓri ɓuuɓri (cystitis).
   • Ɓuuɓri reedu: Ina addana ɓuuɓri, ɓuuɓri, e tenesmus reedu mettuɗo (ina nanndi e aɗa sokli no feewi ɓuuɓri, ko ɗum majjinta ñawɓe e safrooɓe ngam ƴeewndaade ɓuuɓri ɓalndu ɓuuɓndi).
7. Nafoore ina ummoo les les dow ƴiyal ɓalndu (suprapubic) walla so ina yirloo ɓalndu ñaamo ɓuuɓndu nduu e nder (Maande Obturator Positif).
8. Appendix Retroileal / Preileal (Tippudi ɓuuɓndi caggal walla yeeso ɓalndu tokoosru timmundu):
9. Ina mettina ileum distal to bannge laawol, ina addana ɓuuɓri e ɓuuɓri ndiyam mawndi caggal nde ñaami, ina nanndi e tooke nguura walla ñawu Crohn.
10. Malrotaasiyoŋ walla Situs Inversus (Apendisit bannge nano):
11. Ko ina wona 1 e nder 8 000 haa 10 000 neɗɗo ina wondi e mboros biyeteeɗo malrotaasiyoŋ ɓalndu walla situs inversus totalis, ko ɗum addanta apendisit ɓuuɓɗo goonga oo feeñde e kaɓirgal les nano.

Teskuyaaji ɓalli ɗi leefɗi e sara leeso, peeñninɗi ɓuuɓri peritoneal e apendiis¶

Emergency physicians use gentle movement maneuvers rather than painful deep poking to detect peritoneal irritation (peritonism) and locate an inflamed appendix. Aɗa waawi ƴeewtaade ɗeeɗoo maale leefɗe e nder galle walla e nder ladde tawa aɗa ɓuuɓna reedu nduu no feewi :

1. Maande Kosam (Maande Dunphy) e Maande "Jaawgol / Taƴre-Toɓɓere" (Maande Markle)¶

So wonaa ɓuuɓnude no feewi e nder reedu e woppude ("rebound tenderness" aada walla maande Blumberg, ko ɗum addanta sukaaɓe hulɓinaaɓe mette ɗe ngalaa nafoore), huutoroo ƴeewndorɗe dimmbagol leefɗe jogiiɗe 80 haa 85 e nder teemedere sensitivite wonande peritonitis :

• Maande Dunphy (Test ɓuuɓri): Ñaagoɗaa ñawɗo oo yo rokku ɓuuɓri wootiri anniya. So tawii ɓuuɓri ina addana ɓe ɓuuɓde no feewi e nder kaɓirɗe les ñaamo (walla ina addana ɓe ɓuuɓde e reedu maɓɓe les ñaamo e junngo maɓɓe hade maɓɓe ɓuuɓde), peritoneum parietal ina ɓuuɓta.
• Maande Jaawgol Oto / Pothole: So tawii ko e yahde to safrirde, fiyde hay ɓuuɓri laawol tokosiri, rumble strip, walla pothole ina jarna peritoneum ɓuuɓɗo oo, ina addana ñawɗo oo woyde e jogaade reedu mum les ñaamo.
• Markle Sign (Heel-Drop Jarring Test): Have the patient stand on their tiptoes for 2 seconds and then drop flat down onto their heels with a firm thud (or, if lying down, gently tap the bottom of their right heel). Jolngo tiiɗngo e nder ɓalndu les ñaamo ko maande Markle moƴƴere.

2. Maande Rovsing (Nafoore bannge ñaamo nde toɓɓata bannge nano)¶

• Ñawɗo oo ina lelii, koppi mum ina njuuti, ɓuuɓna ɗum no feewi e kaɓirgal les ngal nano (bannge celluɗo reedu nduu).
• Maande Rovsing moƴƴere: So tawii toɓɓude e bannge nano ina wayla ɓuuɓri ɓalndu e ɓuuɓri peritoneal e nder reedu, ina addana ɓuuɓri tiiɗndi nanndundi e dow kaadrant les ñaamo, ina hollita no feewi peritonitis nokkuyankeewo les ñaamo ummoraade e apendisit.

3. Maande Psoas (Yiytude appendix retrocecal suuɗiiɗo caggal ɓalndu)¶

• Haa ñawɗo oo lelna e bannge nano maɓɓe. No feewi, ɓe njuɓɓina koyngal maɓɓe ñaamowal, ɓe njaajna koyngal maɓɓe ñaamowal caggal to ŋoral (hono no ɓe njaajnirta yeeso ŋoral nii). Walla, tawa ñawɗo oo ina woni e ɓalewol mum, naamndo-ɗee yo ɓe ƴettu koyngal maɓɓe ñaamowal toowngal dow e junngo maa, ɓe ɓuuɓna no feewi e koppi maɓɓe.
• Maande Psoas moƴƴere: Ɓoornugol walla ɓuuɓnude ɓalndu iliopsoas ñaamo ina ɓuuɓna ɗum no feewi e appendix retrocecal, ina addana ɗum ɓuuɓri les reedu ñaamo walla bannge ɓalndu. (Sukaaɓe heewɓe wonduɓe e apendiis retrocecal ina njaha e nder safrirde ina njuuroyoo yeeso e wuttulo, ina ɓuuɓna wuttulo mum en ñaamo ngam haɗde ƴiiƴam psoas ɓuuɓde).

4. Maande Obturator (Yiytude appendix pelɓondiral ina fawii e dow pelɓondiral)¶

• Ñawɗo oo ina lelii e dow koyɗe mum, ɓuuɓna koppi mum ñaamo e koppi mum ñaamo haa 90 degere, jogoo wuttulo mum ñaamo e koppi mum, ɓuuɓna koppi mum ñaamo ɗii no feewi nder feewde e koyngal nano (yirlo nder koyngal ñaamowal).
• Maande Obturator Positif: Yirlaade hippoode nder ina ustoo ƴiiƴam obturator nder ɓalndu e nder ɓalndu; so tawii appendix pelvic ɓuuɓɗo ina memi oon ƴiiƴam, ñawɗo oo ina nana ɓuuɓri luggiɗndi e nder ɓalndu walla e nder ɓalndu.

Yimɓe teeŋtuɓe ɓurɓe heewde mborosaaji ɗo apendisit ruptata ko yaawi¶

1. Appendicitis e nder reedu (Emergency opération non obstetrique #1 e nder ñawɓe reedu)¶

Apendisit ɓuuɓɗo ina heɓtoo ko ina tolnoo e 1 e nder 1 000 reedu, ɓuri heewde ko e nder lewru ɗiɗaɓuru. So tawii maayde yumma e apendisit mo alaa ko saɗti ina ɓadii 0, perforaasiyoŋ apendiis ina ɓeyda ŋakkeende ɓiɗɗo (ɓiɗɗo jibinaaɗo walla jibinannde ko adii nde o jibinaa) gila e 1,5 e nder teemedere haa e ko ɓuri 20 haa 35 e nder teemedere, sibu peritonitis bakteriiji ina addana reedu ɓuuɓde e ɓuuɓtude koleonitis e nder reedu.

• Displacement anatomique de l’appendice à la haut par l’utérus croissant: No reedu reedu nduu yaajirta e nder reedu caggal yontere 12, ina ɓuuɓna cecum e appendix oo no feewi dow e yaasi:
• Lewru adanndu (Aset 1 haa 12): Nafoore ina woni haa jooni e toɓɓere McBurney e nder ŋorol les ñaamo.
• Cakkital lewru ɗiɗaɓuru (Hedde yontere 20 haa 24): Appendix ina ɓuuɓtoo dow haa to tolno umbilicus (redu) e bannge ñaamo.
• Lewru tataɓuru (Aset 28 haa 40): Appendix ina ɓuuɓnee toownde e nder Quadrant supérieur droit (RUQ) les ɓuuɓri ñaamo, ɗo ɗum heewi seertude e... ɓuuɓri galle, piyelonefritis, walla mboros preeklamsi/HELLP.
• Why abdominal guarding is masked in pregnancy: Because the growing uterus stretches and lifts the anterior abdominal wall muscles away from the inflamed appendix, pregnant patients often have minimal rebound tenderness or abdominal rigidity until perforation has already occurred. Kala ñawɗo reedu mo ɓuuɓri reedu kesiri bannge ñaamo (so tawii ko les, hakkunde, walla toowndi les ɓuuɓri) ina foti ƴeewteede ɗoon e ɗoon e nder suudu safrirdu tawa ina waɗi ultrason reedu e ƴeewndo magnetik (MRI) mo alaa ko seerndi ɗum.

2. Sukaaɓe tokosɓe e sukaaɓe tokosɓe ɓe duuɓi mum en njahrata e 5 (Perforation 50 haa 80 e nder teemedere)¶

E sukaaɓe ɓe duuɓi mum en njahrata e 5, ko ina ɓura feccere e ñawɓe apendisit ɓee ina njuuti gila nde ɓe njottii suudu safrirdu sabu :

• Sukaaɓe tokosɓe mbaawataa siftinde "nafoore periumbilical migrating to McBurney point" e nokku mum ina tawee e bojji ɗi mbelnaaki, salaade ñaamde hay ko ɓuri welde e ñaamde, ɓuuɓri, ɓuuɓri, nguleeki, e salaade yahde walla diwde (walla yahde e ŋoral koyngal ñaamowal).
• To bannge anatomi, omentum mawɗo cukalel tokosel (rido fatty mo murlitaaki e ñawuuji reedu e nder mawɓe) ina selli no feewi, ina juuti, ko ɗum waɗi so appendix cukalel tokosel ina ɓuuɓtoo, ina famɗi ɗo ɗum waɗata ɓuuɓri laaɓndi ; ko noon ne kadi, ina ɓuuɓta e yaawre e nder peritonitis kuuɓtodinɗo mo mbaydiiji nay.
• Test Jump Pediatric: E nder cukalel gollondirngel ngel duuɓi 3 haa 10 ngel ɓuuɓri reedu mum laaɓaani, safrooɓe emergency ina ɗaɓɓa e cukalel ngel hoppitde dow e les laawol gootol e koyngal gootal walla diwde les gila e les ŋoral taabal jaŋde. Cukalel ngel weltaare diwata dow e les, ngel jippoo e koyɗe mum tawa ngel ɓuuɓnaaki, ngel meeɗaa heɓde peritonitis ɓuuɓɗo walla apendisit yahruɗo yeeso.

3. Mawɓe ɓe duuɓi mum en njahrata e 65 (perforaasiyoŋ ina tolnoo e 40 haa 70 e nder teemedere e maayde ina tolnoo e laabi 5 haa 10)¶

E mawɓe mawɓe, ɓuuɓri ɓalndu nduu ina jokkondiri e duuɓi, ɓuuɓri ɓalndu nduu, e ɓuuɓri reedu nduu, ina firta wonde ɓalndu nduu ina waawi waylude gangrene e perforaade e nder waktuuji 12 tawi ñawɗo oo ina jogii fever va.logue, a normal cell and walla jiiɓru kesu. Hoto meeɗ woppude ɓuuɓri les reedu ñaamo walla ŋakkere ñaamde e nder mawɗo mawɗo ko ɓuuɓri ɓuuɓri walla ɓuuɓri ƴiiƴam.

Mimic surgical appendicite kulɓiniiɗo nguurndam a fotaani waasde¶

So tawii ɓuuɓri les ñaamo walla les reedu ina heɓtoo, safrooɓe safrooɓe ina ƴeewtoo ɗoon e ɗoon ñawanɗe nay caɗtuɗe e sahaa, nannduɗe e apendisit ɓuuɓɗo :

Ballal gadanal hade safrirde e ko kewata e departemaa urgence¶

Toppitagol ko adii opitaal e nder yahdu to opitaal¶

1. Reentaade ngonka NPO tiiɗka (Alaa ko woni e hunuko): Woto ndokku ndiyam, teewu, ɓuuɓri, ɓuuɓri, antacids, walla tablette ɓuuɓɗe e hunuko. So tawii hunduko ñawɗo oo ina yoori, ina yoori, yo ɓe ɓuuɓnu ndiyam ngulɗam tokosam, ɓe ɓuuɓna ɗum walla ɓe ɓuuɓna leppi maɓɓe e lootorde ɓuuɓnde tawa ɓe ɓuuɓnaaki.
2. Position pour la relaxation peritoneale: So tawii ko e faddaade ambulance walla e yahde e jooɗorde yahooɓe e oto, ɓuuɓna jooɗorde ndee seeɗa, waɗa jacket walla pillow follaa les koppi ñawɗo oo mbele koppi maɓɓe e koppi maɓɓe ina keddoo ina ɓuuɓtoo e 30-to-45-degree angle. Haa sofereeɓe ɓee njillotoo e ɓulli ɗii, ƴetta ɓulli njaaweeki e ŋoral.
3. Reento maskude walla bonnude emergency e leɗɗe galleeji:
4. Hoto meeɗ rokkude AINE (ibuprofen, naproxen, aspirin, ketorolak) hade seppo : AINE ina haɗa ɓuuɓri ƴiiƴam, ina ɓeyda ƴiiƴam nder seppo e nder seppo, tawa ina ustoo reedu e ƴiiƴam ñawɗo mo ndiyam mum ŋakki.
5. Woto meeɗ rokkude laksatif walla enema.
6. Tesko e reentaade ñawu nguu e nder safrirde: So ñawɗo oo yettiima to suudu safrirdu, laabi seppooji jamaanu ina kollita wonde safrooɓe ina poti waɗde analgesia titrated (hono morfin, fentanil, walla asetaminofen) ɗoon e ɗoon. Duuɓi capanɗe jarribooji ranndomaatik kollitii wonde ustude ɓuuɓri e nder ƴiiƴam no haanirta nii e nder departemaa emergency ina addana ñawɓe ɓee wellitaare no feewi ngam gollodaade e ƴeewndo ngoo kadi maskaani maale peritoneal walla ustude laaɓal ƴeewndo so hawraama e ƴeewndo ultrasound walla CT.

No safrooɓe njiyrata e safrude apendisit ɓuuɓɗo vs ruptur¶

• Toɓɓere e Natal: Cafrooɓe urgency ina kawra e kuutorɗe toɓɓere safaara (hono Toɓɓere Alvarado / MANTRELS walla Toɓɓere Appendicitis mawɗo) e maandeeji laboratuwaar (limto ƴiiƴam ɓalejam, mbayliigu neutrophiles, protein C-reactive test, e ƴeewndo pregnancy :
• Ultrasound Point-of-Care and Radiology: Teskuyaaji gadani e nder sukaaɓe, sukaaɓe tokosɓe, e ñawɓe reeduɓe (radiation zero; ina yiyloo apendiis tuubaako ɓuuɓɗo mo ɓuuɓnataa, ɓurɗo yaajde e 6 milimeeteer e njaajeendi mum, tawa ina waɗi maande target walla apendikoliit).
• CT Scan reedu e pelvis e IV contrast: Test gonɗo e mbaydi kaŋŋe e nder mawɓe ɓe ngalaa reedu (>95 haa 98 e nder teemedere sensitivite e keertinagol; ina anndita apendisit gadano, ngonka retrocecal, fecaliths, henndu ɓuuɓndu, e abscess periappendix).
• MRI mo alaa ko seerndi ɗum: Huutortee ko e ñawɓe reedu nde ultrasound waawaa yiytude no laaɓiri appendix caggal reedu.
• Apendektomi laparoskopi e antibiyotik IV yaajɗo:
• Apendisit ɓuuɓɗo mo alaa caɗeele: Safretee ko e antibiyotikuuji gonɗi e nder ƴiiƴam (ina ɓuuɓna ƴiye Gram-negatif hono E. coli e anaerobeeji hono Bacteroides fragilis, ko wayi no seftriakson e metronidazol taƴe keyhole, ko ɓuri heewde e ñawɓe ina ngarta galleeji mum en e nder waktuuji 24. (E nder geɗe cuɓaaɗe ɗe caɗtaani ɗe ngalaa hayre apendikolit e CT, njuɓɓudi antibiotik ndi alaa ko gollotoo ina waawi yeewteede e seernaaɓe, hay so tawii noon fotde 30 haa 40 e nder teemedere ina rewtoo e nder duuɓi 1 haa 5, tawa kadi woodgol apendikolit kalsifiyee ina addana requite surgery toowɗo ŋakkeende e perforation).
• Appendix perforé e peritonitis diffuse : Ina ɗaɓɓi ndiyam ɓuuɓɗam e nder ƴiiƴam, antibiotikuuji ɓuuɓɗi e nder ƴiiƴam, e appendektomi e lootgol peritoneal e nder sahaa gooto.
• Ko ina waɗi flegmon periappendix walla abscess walled-off (Hollitde ko ɓooyi caggal balɗe 5 haa 7): So tawii ñawɗo oo ina fadi balɗe keewɗe caggal nde o ruppitii, tawa omentum ɓurɗo mawnude e ɓanndu nduu ina waawi wallitaade ɓuuɓri ndii e nder poosi ɓuuɓɗo (ɓuuɓri periappendiis generally withoutense) loopeeji ɓalndu ɓuuɓɗi, ɓuuɓɗi ina njogii baasal mawngal e ɓuuɓnude cecum e ɗaɓɓude hemikolektomi moƴƴo. E nder ɗuum, seernaaɓe e radiyoloji gonɗi e nder ɓalndu ina keewi safrude ɓuuɓri gonndi e ɓalndu, ko adii fof e ƴeewndo kateter perkutane gonɗo e nder ɓalndu, tawa ina ardii ɗum e CT walla e ultrasound, tawa ina ɓeyda heen antibiotikuuji gonɗi e nder ƴiiƴam, caggal ɗuum, caggal yontere, ko kolonoskopi (kolonoskopi) jokkondirɗo (haa teeŋti noon e ñawɓe ɓurɓe duuɓi 40 ngam ittude hicto an interdden.

Famde limre Alvarado (MANTRELS) nde safrooɓe safaara kuutortoo¶

So a arii e departemaa emergency tawa aɗa tuuma apendisit, safrooɓe ina njaawna hiisaade tolno mbaawka safaara ko wayi no Toɓɓere Alvarado (siftorde ko akronim MANTRELS, e nder toɓɓe 10) walla Toɓɓere Apendisit Sukaaɓe (PAS) ngam ardude e ƴeewndo ultrasound e

• Toɓɓere 1 haa 4 (Low probability): Ina gasa tawa ko apendisit ɓuuɓɗo, hay so tawii noon ngonka retrocecal walla pelvic e ñawɓe immunocompromis/mawɓe ina ɗaɓɓi haa jooni ƴeewndo laaɓtungo.
• Toɓɓere 5 haa 6 (Hakkunde / Equivocal): Ina ɗaɓɓi ultrasound walla CT scan ɗoon e ɗoon e leeso tawa ina waɗi ƴeewndo nder ƴiiƴam.
• Toɓɓere 7 haa 10 (High probability): Teskagol tiiɗngol e apendisit ɓuuɓɗo, ina ɗaɓɓi ƴeewndo seppo ko yaawi e ƴeewndo laaɓtungo.

Naamne keewɗe naamneede¶

Fuɗɗoode ƴeewtaama¶

• Fedde Adunaare toppitiinde ko fayti e seppooji (WSES): Ƴeewndo e safrude ñawu nguu: 2020 Kesɗitingol kuule WSES Yerusalaam.
• Koolaaɗo kuuɓal Amerik (ACS) e Fedde toppitiinde ko fayti e ñawu nguu (SIS, Amerik): Kuule tuugiiɗe e hujjaaji ngam haɓaade ñawu nguu e nder reedu e ñawu nguu e nder reedu mum.
• Duɗal ngenndiwal toppitiingal cellal e toppitagol (NICE) e duɗal jaaɓi haaɗtirde laamɗo Angalteer (Royaume-Uni): Opereeji kuuɓtodinɗi e nder sahaaji caɗtuɗi: Laabi ƴeewndo e njuɓɓudi appendisit e peritonitis ɓuuɓɗi.
• Koldaa Ameriknaajo toppitiiɗo jibinannde e debbo (ACOG, Amerik): Opereeji ɗi ngonaa jibinannde e nder reedu e ƴeewndo ñawu reedu ɓuuɓngu e nder reedu.
• CODA Collaborative (New England Journal of Medicine): Njiylawu ranndomaatik ngam renndinde antibiyotik e apendektomi ngam apendisit (hollitoowo ɓurde heewde caɗeele e rewrude e ɓuuɓri so apendikolit ina woodi).

Ardiiɓe jokkondirɓe¶

• Sepsis e septik shock anndinde e ballal gadanal e nder sahaa
• Reedu ektopik ruppitiiɗo e ƴiiƴam e nder lewru adanndu
• Torso testikulaar, torso ovarien, e ɓuuɓri pelvic ɓuuɓndi
• Tooke nguura, ɓuuɓri ɓalndu, e ŋakkeende ndiyam
• Shock ballal gadanal e cirkulaasiyoŋ collapse positionnement
• Limooje emergency e leydi