Appendicitis

Question 1

What is appendicitis?

Answer 1

Inflammation of appendix from obstruction where meets bowel, quickly proceed to gangrene and rupture

Question 2

Why is there a risk of peritonitis in appendicitis?

Answer 2

Rupture releases faecal content and infective material into the abdomen

Question 3

How does pain present in appendicitis?

Answer 3

Epigastric -> Right iliac fossa
Pain on McBurneys point on palpation
Generalised if ruptured

Question 4

Where is McBurneys point?

Answer 4

Localised area one third distance form anterior superior iliac spine (ASIS) to umbilicus

Question 5

Features of appendicitiis

Answer 5

Periumbilical pain that owrsens and migrates to RIF over 24-48 hours
Anorexia
N+V
Rosvings sign
Psoas sign -> retrocaecal
Guarding on abdominal palpation
Rebound tenderness increased
Percussion tenderness
Sec abdominal pain RIF
Constipation or diarrhoea

Question 6

What to do do if clinical presentation suggestive of appendicitis but investigations negative?

Answer 6

Diagnositc laproscopy - visualise appendix directly

Question 7

Surgical treat appendicitis

Answer 7

Appendiecectomy

Question 8

Differentials for appendicitis

Answer 8

Ectopic pregnancy
Ovarian cycsts
Meckels diverticulum
Mesenteric adenitis
Appendix mass
Pinworms

Question 9

What should exclude in every woman with sus appendicitis

Answer 9

Pregnancy with Serum or urine bHCG

Question 10

What can ovarian cysts cause?

Answer 10

Pelvic and iliac fossa pain, particuarly with rupture or torsion

Question 11

When does Meckels diverticulum present similarly to appendicitis?

Answer 11

Bleed, inflamed, rupture or cause volvulus or intussusception

Question 12

What is mesenteric adenitis?

Answer 12

Inflamed abdominal lymph nodes

Question 13

What does mesenteric adenitis present with?

Answer 13

Tonsiliitis or URTI
Abdo pain

Question 14

What is Meckel’s diverticulum?

Answer 14

Malformation of distal ileum. Usually asymtpomatic

Question 15

How does an appendix mass occur?

Answer 15

Omentum surrounds and sticks to inflamed appendix forming mass in RIF
Conservative management + antibiotics, appendectomy

Question 16

What are the complications of an appendicectomy

Answer 16

• Bleeding, infection, pain and scars
• Damage to bowel, bladder or other organs
• Removal of a normal appendix
• Anaesthetic risks
• Venous thromboembolism (deep vein thrombosis or pulmonary embolism)

Question 17

What happens to pain when appendicitis ruptures

Answer 17

It increases gradually then suddenly disappears when bursts -> peritonitic

Question 18

Symptoms appendicitis

Answer 18

-Periumbilical or epigastric pain relatively sudden onset worsening and migrating to RIF 24-48 hrs
-Fever - low grade, general malaise, anorexia
N+V
-Constipation (or sometimes diarrhoea)

Question 19

What is psoas sign

Answer 19

Passive extension right thigh in L lateral position elicits pain in RLQ
Suggests retrocaecal appendicitis

Question 20

What is Rosvings sign

Answer 20

Palpation of LLQ -> increased pain in RLQ

Question 21

What is obturators sign

Answer 21

Passive internal rotation of flexed right thigh elicits pain in lower quadrant
Obturators sign means irritating obturator nerve

Question 22

Investigations for appendicitis

Answer 22

US
Urine dip - UTI and pregnancy
Bloods - FBC - neutrophil predominant leucocytosis (80-90% people)
CRP
UEs, LFTs and amylase

Question 23

When use CT in appendicitis

Answer 23

Indeterminate findings from US if may not have op

Question 24

What is problem with US in appendicitis

Answer 24

Retrocaecal organ - difficult to visualise

Question 25

What see on US in appendicitis

Answer 25

Fat stranding/wrapping and free fluid

Question 26

Where is the appendix

Answer 26

Ileocaecal junction Blind ending structure with end artery

Question 27

Management of appendicitis

Answer 27

Prep for surgery - nil bu mouth Appendicectomy Antibiotics Resus fluids

Question 28

What is there a risk of even after appendicectomy

Answer 28

Stump appendicitis If not whole appendix resected

Question 29

What always test for in teenage girls with abdominal pain

Answer 29

PREGNANCY

Question 30

What does pre-ileal and post-ileal appendix present with

Answer 30

D+V - irritaiton of distal ileum

Question 31

What does pain location in appendicitis depend on

Answer 31

Anatomical positon of appendix - can get pelvic appendix - suprapubic pain etc Pre-ileal and post-ileal appendix - V+D Retrocaecal/Retrocilic - RIF and +psoas test

Question 32

When do non-operative management in appendicitis

Answer 32

Negative imaging Uncomplicated acute appenditicits High recurrence rate