The scanning and localization of Acute Appendicitis.

This video shows the scanning and localization of Acute Appendicitis.
Sonographic criteria for a diagnosis of appendicitis include a noncompressible, blind-ended, aperistaltic tubular structure in right lower quadrant arising from the base of the cecum.
An ultrasound examination is performed to evaluate for Appendicitis. Graded compression ultrasound of the right lower quadrant will reveal a non-compressible, enlarged appendix. If the bowel wall layers, particularly the echogenic submucosa, are lost, it is suggestive of perforation.
The Appendix is a small, pouch-like sac of tissue that is located in the first part of the colon (cecum) in the lower-right abdomen. Lymphatic tissue in the appendix aids in immune function. The official name of the appendix is a vermiform appendix, which means "worm-like appendage." The appendix harbors bacteria.
This is a case where the patient is experiencing pain in Rt. Iliac fossa. When acute appendicitis is suspected, scan the patient lying supine. I selected a high-power ( from 07 to 11 MHz ) transducer. You may put a pillow under both knees to have the abdomen of the patient relaxed. You will search for a blind-ending tubular structure arising from the cecum. First of all, we will identify the ascending colon. Then one has to scan inferiorly to localize the caecum, and then one can see the Appendix. The colon will have the haustra which will differentiate it from the small bowl. You can see the haustra in the long-axis view. Now you will scan caudally to reach the inferior end of the caecum. Now you have to sweep the probe to do the examination in the transverse plane or axial plane (also called the horizontal plane or transaxial plane). The position of the appendix is variable from patient to patient so you will have to look around the caecum to localize the Appendix. The localization of the Psoas muscle is also important as the appendix is often seen overlying it. You will start by applying gentle pressure, then apply firmer pressure to displace the bowel to avoid bowel gases. As the bowl loops are inflamed, they are fixed without peristaltic movements. Most often tenderness will help you to localize the appendix. The appendix is seen on the cross-sectional scan as a concentric circle. You can see that the inner lumen is hypoechogenic with hyperechogenic edema surrounding it. Now if you can on the long axis, the appendix will appear in tabular form with the same pattern.
Inflammation may occur when the appendix becomes infected or blocked with stool, foreign objects, or a tumor.
Appendicitis is a condition in which the appendix becomes inflamed, swollen, or infected, causing pain in the lower right side of the lower abdomen.
Ultrasound can identify an enlarged appendix or an abscess. It is said that during appendicitis, an enlarged inflamed appendix or abscess can be seen in only 50% of patients. But I personally think that in expert hands it may be almost 100 percent.
This video shows the localization of the inflamed Appendix. A small amount of free fluid is also seen in the lower abdomen in this case.
It is not easy to localize the appendix but once you practice it, it looks much easier. Practice makes a man perfect you know
An ultrasound is a painless procedure that uses sound waves to provide images to identify organs within the body. Ultrasound can identify an enlarged appendix or an abscess. Nevertheless, during appendicitis, an enlarged inflamed appendix or abscess can be seen in only 50% of patients.
Applying compression during scanning improves the image quality by reducing the distance between the probe and the bowl.
Signs and symptoms of appendicitis may include:
Sudden pain begins on the right side of the lower abdomen.
Sudden pain begins around your navel and often shifts to your lower right abdomen.
Pain that worsens if you cough, walk, or make other jarring movements.
Nausea and vomiting.
Loss of appetite.
What causes a rupture? The exact cause is unknown for sure, but it is thought it’s probably due to an infection that triggers inflammation inside Appendix.
Classical symptoms of appendicitis include:-
-Fever
-Nausea and vomiting
-Abdominal pain may start in the upper or middle abdomen but usually settles in the lower abdomen on the right side
-Abdominal pain that increases with walking, standing, jumping, coughing, or sneezing
-Decreased appetite
-Constipation or diarrhea
-Inability to pass gas
-Bloated or swollen abdomen
-Abdominal tenderness when you push on it that may worsen when you quickly stop pressing on it.
The haustra (singular haustrum) of the colon are the small pouches caused by sacculation (sac formation), which give the colon its segmented appearance. The teniae coli runs the length of the colon. Haustral contractions are slow segmenting, uncoordinated movements that occur approximately every 25 minutes.