Acute appendicitis

Question 1

Anatomy of appendix

• Location
• blood supply

Answer 1

Pouch, blind ended, off the caecum
- around 5-10cm

Originally a foregut structure

Location

• Most commonly retrocaecal
• Others: pelvic, retroileal, retrocolic

Blood supply

• Small mesentery= appendicular artery
• Terminal branch of ileocolic, if thrombosis occurs, can cause gangrene

Question 2

Acute appendicitis

- Definition

Answer 2

Inflammation of appendix most likely due to obstruction

• Faecolith
• stool
• Infective agents
• Lymphoid hyperplasia

Types

• Simple/ non-perforated
• Perforated

Question 3

Risk factors

Answer 3

Age
- 10-20

M>F

Frequent antibiotic use

Low fibre

Smoking

Question 4

Complications of appendicitis

Answer 4

Perforation—> generalised peritonitis

Appendix mass/ abscess

Adhesions

Sepsis

Question 5

Symptoms of appendicitis

Answer 5

Abdominal pain

• Peri-umbilical/ epigastric, migrates to RIF
• Pain moves when abdominal wall peritoneum becomes inflammed
• Worsened by movement

Anorexia

Nausea

Constipation

Vomiting
- Sign of more severe

Question 6

Investigations for appenditicitis

Answer 6

Bloods

• FBC = Increased WCC
• U+E= Na, K
• CRP= raised, esp with WCC

Abdominal + pelvic CT
- Wall thickening and enhancement of appendix

Abdominal USS if CT not suitable

Pregnancy test and urinalysis to rule out other differentials.

Question 7

Management of appendicitis

Answer 7

NBM and IV
- Analgesia

Appendicectomy

• Lap or open
• Co-amoxiclav initially, continue if perforation is indicated

Question 8

Appendicectomy

Answer 8

Lap
- Uncomplicated, complicated and perforated

Open
- Better for pregnant women

Follow up
- Short recovery time (1 day)

Question 9

Appendicectomy

Answer 9

Lap
- Uncomplicated, complicated and perforated

Open
- Better for pregnant women

Follow up
- Short recovery time (1 day)

Question 10

Appendicectomy

- Complications

Answer 10

Perforation

Generalised peritonitis

Appendicular mass or abscess

Wound infection

Question 11

Classifications

Answer 11

Mucosal
- Mildest

Phlegmonous
- Slow onset, slow progression

Necrotic

• Acute bacterial infection cause
• Ischaemic necrosis
• High perforation risk

Question 12

Signs

Answer 12

Fever

Tachycardia

Abdominal tenderness

• Especially at McBurney’s point
• Guarding= peritonism, perforation

Rovsing’s sign
- palpating LIF makes pain worse in RIF